Dose reduction is required in renal failure with all except:
Ans. C. DoxycyclineDose reduction is needed in case of following conditions:* Drug causing nephrotoxicity as adverse drug reaction* Drug excreted through renal routeAmphotericin B is most nephrotoxic among antifungals. Even liposomal preparations of amphotericin B (c-AMB, LAMB, ABCD, ABLC) are nephrotoxic, though less as compared to conventional Amphotericin B.More than 90% of vancomycin is excreted through glomerular filtration.In case of renal failure, there may be less excretion which leads to toxicity of Vancomycin due to its striking accumulation in body (ototoxicity, nephrotoxicity, red man syndrome). Half-life of vancomycin can increase to 6-10 days in case of anephric patients.Gentamicin is an aminoglycoside. Aminoglycosides are most potent to cause both ototoxicity and nephrotoxicity. Aminoglycosides are excreted almost entirely by glomerular filtration. High concentration of aminoglycosides is found in otic fluid and by virtue of the process of elimination: high concentration is found in urinary tract.Dose modification required in renal failure.* Cockcroft-Gault equationCCr =72xSCr (140-Age)xWeight(kg) CCr = creatinine clearance (expressed in mL/min); SCr = serum creatinine (expressed in mg/dL)Among tetracyclines, minocycline and doxycycline are safe in renal impairment cases. Doxycycline does not cause nephrotoxicity and is excreted through bile. Other tetracyclines can cause Fanconi syndrome characterized by toxic metabolite accumulation (tetracyclines and epihydrotetracyclines).So, answer is Doxycycline.
Amphotericin B
Vancomycin
Doxycycline
Gentamicin
Anti Microbial