A 72-year-old patient with CKD (CrCl 15 mL/min) requires antibiotic therapy. Which of the following antibiotics requires the LEAST dose adjustment due to its primarily hepatic/biliary elimination?

• A Aminoglycoside (gentamicin)
• B Ciprofloxacin
• C Vancomycin
• D Ceftriaxone ✓

Explanation

Ceftriaxone is unique among cephalosporins in being predominantly eliminated unchanged in bile (approximately 40% biliary excretion), requiring minimal to no dose adjustment in renal failure. Gentamicin and vancomycin are almost entirely renally eliminated and require significant dose reduction and monitoring in CKD. Ciprofloxacin has dual renal and hepatic elimination and requires moderate adjustment.

Reference: KD Tripathi, Essentials of Medical Pharmacology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.