If you’re living with chronic kidney disease (CKD), managing infections safely is an essential part of protecting your overall health. When your kidneys aren’t working properly, medications can build up in your body and cause harm. If you have renal failure, certain antibiotics can be particularly risky, so if you have a UTI or other infection or need to take an antibiotic in preparation for a medical test, your doctor will choose your antibiotic carefully and may adjust the dosage or schedule to help keep your kidneys safe.* 

Which Antibiotics Are Considered Safer

Not all antibiotics are dangerous when you have kidney disease, but their safety can depend on how well your kidneys are functioning, as determined by your estimated glomerular filtration rate (eGFR). A lower eGFR means your kidneys aren’t clearing waste as effectively, which affects how your body handles medications.

Some antibiotics that experts generally consider safer for people with CKD include:

• Ceftriaxone (Rocephin)
  
• Clindamycin (Cleocin)
  
• Doxycycline (Acticlate)
  
• Moxifloxacin (Avelox)
  
• Azithromycin (Zithromax)
  

While these may be options for you, the list is limited, so your doctor may recommend other antibiotics, but with important adjustments—like changing the amount or how often you take them—to help reduce strain on your kidneys.

Which Antibiotics Can Be Riskier

Some antibiotics can put extra stress on your kidneys, especially if they aren’t dosed properly. For example, aminoglycosides—like tobramycin or gentamycin—are known to cause kidney damage. One called amikacin may still be used, but your doctor will be very cautious and adjust your treatment plan accordingly.

Your care team will consider several factors when prescribing antibiotics:

• How advanced your CKD is
• The type of infection you have
• Any other conditions, like diabetes or high blood pressure
• Your risk for side effects

If you’re on hemodialysis, timing also matters. Some antibiotics, like cefazolin, may be given right after a dialysis session to avoid buildup in your bloodstream. Your doctor may also monitor you closely to catch any signs of worsening kidney function early.

Some Other Common Adjustments

Even if an antibiotic is potentially risky, your doctor can often make it safer by adjusting how much you take or how often you take it:

• Lower doses. Some antibiotics, such as penicillins and cephalosporins, work well with smaller amounts.
• Longer intervals. Others, like fluoroquinolones (e.g., ciprofloxacin, levofloxacin), might be given less frequently to allow your body more time to process them.
• Macrolides. These types of antibiotics, such as erythromycin, azithromycin, and clarithromycin, are typically given at half the usual dose when kidney function is more severely impaired.

Taking the wrong dose can lead to serious side effects, including:

• Confusion,  
• Seizures,  
• Nerve pain, or even 
• Tendon problems. 

It’s important to always tell your doctor if you notice anything unusual while on antibiotics.

If you have CKD, not every antibiotic is off-limits—but how you take them matters. You and your care team can work together to find the safest and most effective treatment by considering your kidney function, the type of infection, and your overall health. Don’t hesitate to ask questions or bring up concerns. Being informed and proactive helps protect your kidneys and keeps you healthier for the long term.

*Caporuscio, J. (2023, January 13). What antibiotics are safe in people with renal failure? Medical News Today. https://www.medicalnewstoday.com/articles/antibiotics-safe-in-renal-failure 

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