A 65-year-old man on maintenance hemodialysis needs therapy for community-acquired pneumonia with possible atypical coverage. Which tetracycline-class agent can be prescribed without dose adjustment because it is cleared predominantly by nonrenal routes?

• A Tetracycline
• B Oxytetracycline
• C Demeclocycline
• D Minocycline ✓

Explanation

Among older tetracyclines, doxycycline and minocycline are the two eliminated mainly by nonrenal mechanisms, so their half-lives are unchanged in renal failure and accumulation does not occur; either is acceptable here. Tetracycline and oxytetracycline depend heavily on urinary excretion and accumulate in renal impairment, worsening uremia through their catabolic effect. Demeclocycline is likewise renally relevant and is now rarely used therapeutically.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.