Macrobid, elderly patient with 3rd stage renal disease


Q: My 81 year old parent was prescribed Macrobid as a second round attack on a bladder infection (3 day Cipro 4 weeks previously). Parent has 3rd stage renal disease. 5 days into the treatment, patient had nighttime spike in fever of 103.4. Took to ER next day, fever still 101.3. ER prescribed Cipro and said continue with Macrobid.

I called pharmacy to find out if the meds should be staggered.The pharmacist was shocked that parent had been given prescription for Macrobid and explained why (elderly, kidney disease, antibiotic less effective if can't achieve concentration needed). I researched and found it on the BEERS criteria rated as a potentially inappropriate drug because of kidney issues. I was very concerned and called after hours service and dr. on call said stop the Macrobid since Cipro was more effective and stronger.

MY QUESTION: is the original prescribing doctor clueless? Am I am over-vigilant and wrong? Should Macrobid be given to someone with 3rd stage kidney disease especially when on a 32 ounce daily liquid limit? Which as I understand it makes the antibiotic ineffective (needing to bind to the protein in the urine).

Symptoms:  Bladder infection

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