Abstract

Inappropriate use of drugs in patients with renal impairment may be harmful and may have deleterious effects on health outcomes. A case of 75 year old female patient with systemic hypertension, type 2 diabetes mellitus, chronic renal failure and urinary tract infection has been discussed. Both fasting and random blood sugar levels were elevated. Laboratory data showed increase in serum urea and creatinine levels. Urine culture and sensitivity study showed the presence of Escherichia coli and was found to be sensitive to amikacin, cefepime, meropenem and nitrofurantoin. On the day of admission, the patient was in end stage renal disease as her calculated glomerular filtration rate was 11.3ml/minute. Modified Diet for Renal Disease equation was used to calculate glomerular filtration rate and dose adjustments were made accordingly. Drugs prescribed include glipizide 2.5 mg, sulbactum 1 g , pantoprazole 40 mg, paracetamol 650 mg, prulifloxacin 600 mg, sodium citrate 10 ml, fexofenadine 60 mg, balofloxacin 100 mg, hyoscine 20 mg, domperidone 10 mg, ciprofloxacin 500 mg, ramipril 5 mg and lactulose 10 ml. A systematic medication chart review revealed that ciprofloxacin is the drug of choice with altered dose recommendations for the case of interest while prulifloxacin and balofloxacin has to be used with caution in severe renal insufficiency. Either reduced dose or increased dosing interval is necessary for ciprofloxacin and ramipril in the selected patient. Also, the review has documented other drug related problems such as major drug-drug interaction of fluoroquinolones with glipizide and therapeutic duplication of fluoroquinolones. This case study serves as a potential source of information for the management of urinary tract infection in patients with chronic renal insufficiency.

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