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Management of patients with renal disease |
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¨ Awareness of reduced resistance to infection ¨ Antibiotic prophylaxis for bacteraemia producing procedures should be considered, and is required for at least 2 years post transplant ¨ Best treated under local anaesthetic ¨ May be taking corticosteroids, and may require steroid cover ¨ The day after dialysis treatment is the optimum time for treatment ¨ Cardiac arrhythmia ¨ Impaired drug excretion – care is required when prescribing drugs
Prescribing for patients with Renal Disease
Many drugs prescribed by dentists are excreted by the kidney. Failure to excrete a drug or its metabolites may lead to toxicity. As a general rule any drug that is nephrotoxic (such as gentamicin which may be used in prophylaxis against endocarditis) should be avoided. Other drugs may require dose reduction. Erythromycin is contraindicated in patients who have had a kidney transplant and are taking cyclosporin. Cyclosporin metabolism is reduced leading to an increase in toxicity.
Drugs contained in the Dental Practitioners Formulary whose dose should be reduced in the presence of significant kidney disease include the antimicrobials acyclovir, amoxicillin, ampicillin, cefalexin and erythromycin. Tetracyclines other than doxicycline should be avoided. Non-steroidal analgesics should not be prescribed in those with more than mild renal impairment, paracetomol being the drug of choice for post-operative pain control. Drugs used in dental sedation should be used with extreme care as a greater effect than normal may be produced.
Ref: British Dental Journal 23 August 2003; Volume 195, No. 4
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