As i was going through a self test in pharmacology, i ran on this difficult question that i still can’t find its answer.
The question is:

A seventy-year-old male is admitted to the hospital with meningitis, the lab tests were positive for streptococcus pneumoniae.
The patient has an impaired renal function.
What course of treatment is indicated?

Could you please help me out here, because the senior students said that our Pharmacology Doctor just loves this kind of questions.

Thank you

عزيزي الخيار الأول لدينا هو Cifotaxime لهذا العمر وهذا النوع من الجراثيم. أو حتى Ceftriaxone مع أو بدون Vancomycin

ما في حاجة لتغيير الجرعة في ضعف الوظيفة الكلوية إلا إذا كان الضعف شديد.

Impaired renal and hepatic function: In patients with impaired renal function, there is no need to reduce the dosage ofceftriaxoneprovided that the hepatic function is intact.
In case of severe renal failure (creatinine clearance <10 mL/min) the ceftriaxone dosage should not exceed 2 g daily. In patients with liver damage, there is no need for the dosage to be reduced provided renal function is intact.
In cases of concomitant severe renal and hepatic dysfunction, the plasma concentrations of ceftriaxone should be determined at regular intervals. In patients undergoing dialysis no additional supplementary dosing is required following the dialysis. Serum concentrations should be monitored, however, to determine whether dosage adjustments are necessary, since the elimination rate in these patients may be reduced.

http://home.intekom.com/pharm/ranbaxy/oframax.html

اقرأ أيضاً:
http://www.cipladoc.com/therapeutic/...on=disp&id=389
http://www.tufts.edu/med/apua/Newsletter/13_3a.html