What is the recommended intravenous (IV) dose of ceftriaxone (a third-generation cephalosporin antibiotic) for a urinary tract infection (UTI) in a 99-year-old female (YOF) with chronic kidney disease (CKD) and impaired renal function, as indicated by an estimated glomerular filtration rate (eGFR) of 43?

From the Research

For a 99-year-old female with CKD and an eGFR of 43 who requires IV ceftriaxone for a UTI, the recommended dose is 1-2 grams IV once daily, as ceftriaxone is primarily eliminated through biliary excretion rather than renal clearance 1.

Key Considerations

• No dosage adjustment is necessary for ceftriaxone in this patient despite her reduced renal function.
• The duration of therapy typically ranges from 7-14 days depending on the severity of the infection and clinical response.
• For complicated UTIs in elderly patients with comorbidities, a 10-14 day course is often appropriate.

Monitoring and Precautions

• Monitor renal function during treatment and assess clinical response after 48-72 hours.
• Watch for potential side effects including diarrhea, elevated liver enzymes, and allergic reactions.
• If the patient has a history of severe penicillin allergy, caution is warranted due to potential cross-reactivity.
• Ensure adequate hydration during treatment to support both renal function and recovery from the UTI.

Additional Considerations

• Ceftriaxone therapy should be considered carefully in patients with complicated UTIs due to the possibility of enterococcal re-infection and consequent prolonged hospital stay 2.
• Alternative therapies, such as amoxicillin-clavulanate, may be considered for ceftriaxone non-susceptible UTIs 3.