By Dr. Rebecca L. Castillo

Infections are a serious concern for people with chronic kidney disease (CKD). As kidney function declines, the immune system weakens, making infections more frequent, more severe, and harder to treat. Early recognition and proper management can prevent hospitalizations and further kidney damage.

When Are Antibiotics Needed?

Not all infections require antibiotics. Antibiotics should be used only when a bacterial infection is likely, such as:

–pneumonia

–urinary tract infection with symptoms

–skin and soft tissue infections

–bloodstream infections

Viral illnesses (like colds or flu) usually do not require antibiotics unless complications arise.

Which Antibiotics Are Preferred?

In CKD, doctors often choose antibiotics that are:

–effective at lower doses

–less toxic to the kidneys

Commonly used options (depending on infection and kidney stage) include:

–amoxicillin or amoxicillin-clavulanate

–cephalosporins

–azithromycin

–doxycycline

Some antibiotics require dose adjustment or must be avoided altogether because they can accumulate and cause harm.

Why Dose Adjustment Matters

Damaged kidneys cannot clear drugs efficiently. Without dose adjustment, antibiotics may:

–build up in the blood

–cause side effects (confusion, seizures, toxicity)

–worsen kidney function

This is why CKD patients should never self-medicate or reuse old prescriptions.

Preventing Infections

–Keep vaccinations updated (flu, pneumococcal, COVID-19)

–Practice good hand hygiene

–Maintain proper wound care

–Control blood sugar and blood pressure

–Attend regular follow-ups

Key message: In CKD, infections must be treated early—but carefully. The right drug, at the right dose, saves lives and kidneys.