A 68-year-old man with chronic kidney disease (eGFR 20 mL/min) requires treatment for scrub typhus. Which tetracycline can be given without dose adjustment because it is eliminated by non-renal mechanisms?
- A Tetracycline
- B Oxytetracycline
- C Doxycycline ✓
- D Demeclocycline
Correct answer: C. Doxycycline
Explanation
Doxycycline is unique among tetracyclines because its clearance is predominantly fecal and non-renal, so it does not accumulate in renal failure and needs no dose adjustment. Tetracycline, oxytetracycline and demeclocycline are all renally excreted and accumulate in renal impairment, worsening azotemia through their antianabolic effect. This property makes doxycycline the tetracycline of choice in patients with significant renal dysfunction.
Reference: Katzung Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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