From the Research
For elderly females with chronic kidney disease (CKD) and urinary tract infection (UTI), cephalexin 500 mg twice daily for 7 days is a recommended antibiotic option, as it has minimal renal adjustment needed and is effective against common uropathogens, as supported by a recent study 1. When considering the treatment of UTIs in elderly females with CKD, it is essential to balance antimicrobial efficacy with the need to avoid nephrotoxic agents.
- Nitrofurantoin is often avoided due to reduced efficacy with decreased renal function.
- Trimethoprim-sulfamethoxazole (TMP-SMX) at a reduced dose of 80/400 mg once daily for 3-5 days is typically recommended for uncomplicated UTIs, but requires dose adjustment based on creatinine clearance, and its use is associated with a risk of acute kidney injury, as reported in a study 2.
- Cephalexin, on the other hand, has been shown to be effective in treating UTIs, with a study published in the International Journal of Antimicrobial Agents 1 concluding that cephalexin has good early bacteriological and clinical cures in uLUTIs due to non-extended-spectrum beta-lactamase-producing (ESBL) Enterobacteriaceae.
- For more severe infections, ciprofloxacin 250-500 mg daily (adjusted for renal function) may be used, though it carries risks of tendon rupture and C. difficile infection in the elderly. The final antibiotic choice should be guided by:
- Urine culture results
- Local resistance patterns
- The patient's specific GFR level Treatment should be accompanied by increased fluid intake unless contraindicated, and follow-up urinalysis is recommended to confirm resolution, as emphasized in a review of antibiotic prescription in CKD patients 3.