Infections are common in people with renal failure, and doctors must choose safe and effective antibiotics to treat these infections. When doctors prescribe antibiotics that are unsafe for people with renal failure or prescribe inappropriate doses, side effects may occur. This article lists which antibiotics are safe in renal failure and explains what factors a doctor must consider before safely prescribing them. Not all antibiotics are unsafe for people with renal failure. Depending on the severity of kidney disease and the infection that needs treatment, different options are available. Doctors must evaluate the severity of renal failure before prescribing any medication. To do so, they calculate a person’s glomerular filtration rate (GFR). A low GFR means that the kidneys cannot effectively eliminate certain waste products or substances from the blood. Antibiotics that do not depend on kidney filtration are most appropriate for people with renal failure. The following drugs are safe for people with renal failure: This non-exhaustive list of safe antibiotics leaves very few options for doctors. While other antibiotics may be unsafe, different prescribing strategies can provide additional options for treating infections. For example, a doctor can adjust the dose and/or frequency. Which antibiotics can be harmful to someone with renal failure? People living with chronic kidney failure are at risk of accumulating high concentrations of antibiotics in their bloodstream. To prevent this, doctors will avoid prescribing certain antibiotics. Aminoglycosides are a class of antibiotics that cause kidney injury and can worsen kidney failure. Some examples of antibiotics in this drug class are tobramycin (Tobrex) and gentamycin (Garamycin). While amikacin (Amikin) is also an aminoglycoside, doctors may still prescribe it to people with kidney failure but make certain adjustments. Doctors can safely prescribe an antibiotic to people with renal failure by making some cautionary changes, such as using lower doses and less frequent doses. The decision to prescribe an antibiotic that can potentially worsen kidney function is based on the following factors: When prescribing potentially unsafe antibiotics for people with renal failure, doctors may need to follow up and monitor them for signs and symptoms of worsening kidney function. Many medications, including antibiotics, can be safe for people with renal failure if doctors adjust the dosage. Understanding how the antibiotic acts in the body can help determine the most appropriate and safe dosing. When doctors adjust dosage, they will change either the timing of each dose or the amount of medication a person takes each time. To adjust the dosage of beta-lactam antibiotics, doctors will lower the amount of medication a person takes at each dose. The time interval between doses will remain the same. Examples of beta-lactam antibiotics are penicillins, cephalosporins, and carbapenems. Macrolides, such as clarithromycin (Biaxin) and erythromycin (Erythrocin), are safe, but only in certain adjusted doses. For example, doctors reduce the dose of clarithromycin to 50% of the usual dose in people with severe renal failure.

There is a large body of evidence that indicates minocycline possesses some cytoprotective effects beside of antibacterial properties. In this review, we aimed to explain cytoprotective mechanisms and kidney protection of minocycline. In order to find the effects of minocycline on kidney diseases a systematic literature search was performed, according to the guidelines proposed at the PRISMA statement in the electronic databases, including: PubMed, Scopus, and Web of Science up to August 2016, using the term ‘minocycline’ combined either by ‘kidney’ or ‘renal’ and published in English language. The following criteria were included: (1) studies that used minocycline in renal diseases; (2) full-text articles; (3) English language; (4) no limitation in publications with in-vivo or in-vitro and human or animal subjects. Our search provided a total of 1056 articles which 1045 of them were discarded due to not meeting the inclusion criteria. It has been clear that several factors, including apoptosis, oxidative stress, mitochondrial dysfunction and inflammation have pivotal roles in the development and progression of kidney diseases. Minocycline protective properties are via several ways, including anti-apoptotic, free radical scavenging, anti-inflammatory, effect on mitochondrial functions and inhibition of matrix metalloproteinase. This systematic review confirmed that minocycline could have significant effects on treatment of renal malfunctions. However, regarding any possible adverse effects of antibiotics, it appears that more investigation is still needed in this context. Minocycline (7-dimethylamino-6-demethyl-6-deoxytetracycline) is a semi-synthetic broad-spectrum, clinically available as a bacteriostatic antibiotic belongs to the second-generation of tetracycline antibiotics family [1], [2]. The history usage of tetracycline family came back from 1940s [3]. Because of both effectiveness and low adverse side effects, tetracyclines are extensively used for treatment of human and animal infections [4]. Its antibiotic action originates through binding to the bacterial 30S ribosome subunit in a reversible manner and does not allow to aminoacyl transfer RNA to enter the A site of the ribosome and then inhibits protein synthesis [5], [6]. Compare to tetracycline, minocycline has a higher lipophilic solubility, permeability and almost completely gastrointestinal (GI) absorption leading to rapid access to circulation system and more access to target organs as well as easily crossing the blood-brain-barrier [7], [8]. Elimination half-life of minocycline is varying from 11 to 27 h and main elimination ways are urine and stool [9], [10]. There are a large body of evidence that indicate, minocycline has cytoprotective effects for attenuating or treatment of neurodegenerative diseases [11], epithelial ovarian cancer [12], ototoxicity [13], liver diseases [14], spinal cord injury [15], neuropathic pain [16], and kidney diseases [17]. As an anti-apoptotic agent, minocycline inhibits both extrinsic and intrinsic pathways of apoptosis [18].

Medications can impact your kidneys, especially with chronic kidney disease. Learn which drugs may need adjustments to protect your kidney health. Medications save and improve lives, but it can be easy to overlook their risks and side effects, especially if you don't think they apply to you. Twenty-six million Americans have chronic kidney disease and most don't know it. If you don't know how well your kidneys are working, you may not realize that certain medications could be damaging your kidneys and other parts of your body. Both prescription and over-the-counter medications are filtered by the kidneys. This means that your kidneys degrade and remove medications from the body. When your kidneys aren't working properly, medications can build up and cause you harm. It's important to get your kidneys checked and to work with your doctor to make any adjustments to your medication regimen, such as dosing changes or substitutions. This will help prevent any negative effects from the medication, including further kidney damage. You can determine your level of kidney function with a blood test for serum creatinine to calculate an eGFR measurement. An eGFR estimates how well your kidneys are filtering wastes from the blood. The National Kidney Foundation encourages you to learn more about the health of your kidneys in order to protect these vital organs when taking medications. Always speak with your clinician and pharmacist to determine whether the medications that you're taking should be adjusted based on your kidney function. Only make changes to your prescription medications with the supervision of your trained medical practitioner. Ask questions and evaluate the risks and benefits based on your specific health needs. Here are 5 common types of prescription and over-the-counter medications may need to be adjusted or replaced if you have kidney damage. Cholesterol medications. The dosing of certain cholesterol medications, known as "statins", may need to be adjusted if you have chronic kidney disease. Pain medications. If you have decreased kidney function some over-the-counter and prescription pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs), are not recommended because they can reduce blood flow to the kidneys. Certain narcotic pain medications can build up in the body and cause serious problems for patients with chronic kidney disease. Anti-microbial meds. Many anti-fungal, antibiotic and antiviral medications are cleared by the kidneys. It's important that you and your clinician are aware of your level of kidney function so that a kidney-safe medication can be prescribed for your treatment. Diabetes medications.

Infections are an important cause of morbidity and mortality among patients with chronic kidney disease. Therefore, appropriate antibiotic dosing is imperative to achieve positive patient outcomes while minimizing antibiotic dose-related toxicity. Accurately assessing renal function and determining the influence of renal replacement therapy on antibiotic clearance makes drug dosing in this patient population challenging. Furthermore, as technological advances in hemodialysis and peritoneal dialysis occur, research incorporating newer dialysis parameters to guide drug dosing may not be readily available. Currently, there are limited data to guide drug dosing in the setting of automated peritoneal dialysis, short daily hemodialysis, and nocturnal hemodialysis. Antibiotic-dosing recommendations should be carefully evaluated considering the accuracy of the renal function assessment, the similarity of the operating characteristics of the renal replacement therapy studied compared with those being used, and whether the dosing strategy takes advantage of the pharmacodynamic profile of the antibiotic under consideration. After implementing the antibiotic-dosing regimen, therapeutic drug monitoring should occur when possible along with careful monitoring for antibiotic efficacy and safety. Clinical Summary Regardless of the equation used to assess renal function in patients with chronic kidney disease, the calculated renal function is an estimate. Contemporary dialysis modalities such as short daily hemodialysis, nocturnal hemodialysis, and automated peritoneal dialysis typically result in enhanced antibiotic clearance in comparison to three times a week hemodialysis and continuous ambulatory peritoneal dialysis. Reference recommended doses for chronic kidney disease and renal replacement therapy should be considered as initial estimates that need further refinement taking into consideration the accuracy of the renal function assessment, operating characteristics of the renal replacement therapy modality, and antibiotic pharmacodynamic activity. After instituting a particular antibiotic-dosing regimen, careful monitoring should include therapeutic drug monitoring where possible and a detailed monitoring plan outlining efficacy and safety parameters. It is estimated that chronic kidney disease (CKD) affects more than 10% of people globally. 1 This translates to approximately 760 million individuals being impacted with impaired renal function. Infections are a major source of morbidity and mortality in patients with CKD; 2-5 therefore, antibiotics are frequently prescribed for this patient population. 6,7 Because many antibiotics undergo renal elimination, antibiotic doses need to be decreased to prevent drug accumulation and dose-related toxicities. However, dose adjustments need to be balanced with the need to provide appropriate doses to treat infections and prevent bacterial resistance. Accurately assessing renal function and determining the influence of renal replacement therapy on antibiotic clearance make drug dosing in this patient population challenging. Furthermore, as technology for hemodialysis and peritoneal dialysis (PD) advances, research to guide drug dosing incorporating newer dialysis parameters may not be readily available. The current review will discuss general concepts clinicians should consider when making antibiotic dose adjustments for patients with CKD and highlight contemporary antibiotic-dosing challenges. Abbreviations: CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration; MDRD, Modification of Diet in Renal Disease. With respect to the equation that should be used to assess renal function for the purpose of drug dosing, proponents of the Cockcroft-Gault CrCl argue that a majority of the drug-dosing studies were conducted using the Cockcroft-Gault formula. 8 Conversely, proponents of the GFR equations cite that these equations more accurately quantify renal function for patients with low GFRs, the patient group that warrant drug dose adjustments. 12,13,15 Regardless of the equation used to assess renal function, the calculated value is an estimate and does not replace clinical judgment. Renal dosing recommendations can be found in tertiary drug-information resources. However, considerable variability exists between dosing recommendations. 16 Different doses may be recommended for the same level of renal function, renal function ranges for dose adjustments vary between resources, and some dosing recommendations are nonspecific, e.g., “Use with caution in renal disease.” The Food and Drug Administration guidance on pharmacokinetic studies in patients with impaired renal function was first released in 1998. Before that year, there was no regulatory oversight. 17 Limited pharmacokinetic studies before 1998 may explain the vague and conflicting renal dosing recommendations encountered with older compounds. Given the limitations of current renal dose recommendations, the decision to dose-adjust and the dose to prescribe requires careful consideration of patient- and antibiotic-related factors. The most important antibiotic-related factor to consider when adjusting doses for renal function is whether the antibiotic demonstrates concentration or time-dependent pharmacodynamic activities (Table 2). Clinicians should consider whether dose-adjustment recommendations optimize the antibacterial activity.