From the Guidelines
For a 73-year-old male with elevated CRP and obstructive nephropathy on CT scan, the recommended empiric antibiotic therapy would be a carbapenem, such as meropenem, as targeted therapy, due to its broad coverage of gram-negative bacteria, including those that may be resistant to other antibiotics 1. This recommendation is based on the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant gram-negative bacilli, which suggest the use of carbapenems, such as meropenem, for patients with severe infections due to third-generation cephalosporin-resistant Enterobacterales (3GCephRE) 1. The patient's elevated CRP and obstructive nephropathy on CT scan suggest a severe infection, and the use of a carbapenem, such as meropenem, would provide broad coverage of gram-negative bacteria, including those that may be resistant to other antibiotics. Some key points to consider when using meropenem in this patient include:
- Dose adjustment based on renal function, as the patient has obstructive nephropathy, which may affect drug clearance 1
- Monitoring of renal function closely, as the patient already has obstructive nephropathy, which may be exacerbated by the use of certain antibiotics
- Obtaining urine and blood cultures to guide targeted therapy later, as the patient's infection may be caused by a specific pathogen that requires targeted treatment
- Considering the use of other antibiotics, such as aminoglycosides or fluoroquinolones, in combination with meropenem, if the patient's infection is suspected to be caused by a specific pathogen that requires combination therapy 1 Overall, the use of a carbapenem, such as meropenem, as empiric antibiotic therapy in this patient would provide broad coverage of gram-negative bacteria, including those that may be resistant to other antibiotics, and would be consistent with current guidelines for the treatment of severe infections due to multidrug-resistant gram-negative bacilli.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Patient Profile
- 73-year-old male
- Elevated C-reactive protein (CRP)
- Obstructive nephropathy on computed tomography (CT) scan
Relevant Studies
- There are no studies that directly address the best antibiotic to cover a 73-year-old male with elevated CRP and obstructive nephropathy on CT scan 2, 3, 4, 5, 6.
- However, some studies provide information on the use of antibiotics in patients with kidney disease or obstructive nephropathy:
- A study on eravacycline, a newly approved fluorocycline, showed that it has potent broad-spectrum activity against a wide variety of microorganisms, including those that cause complicated intra-abdominal infections and urinary tract infections 4.
- Another study found that ciprofloxacin is relatively safe in patients with solitary kidney and upper urinary tract infection, but caution is required in vulnerable patients 3.
- A study on the role of C-reactive protein in kidney diseases found that elevated serum CRP is a risk factor for acute kidney injury and chronic kidney diseases, but it does not provide information on the best antibiotic to use in these cases 6.
Antibiotic Options
- Eravacycline may be a potential option for treating complicated urinary tract infections, but its use in patients with obstructive nephropathy is not well-studied 4.
- Ciprofloxacin may be used in patients with solitary kidney and upper urinary tract infection, but its safety in patients with obstructive nephropathy is not well-established 3.
- Other antibiotics may be considered based on the specific causative pathogen and the patient's renal function, but more research is needed to determine the best antibiotic to use in this scenario 2, 5.