Before discharging a patient with chronic kidney disease who is on nitrofurantoin, which action is appropriate?

Nitrofurantoin is primarily cleared by the kidneys, and its use in patients with chronic kidney disease poses significant safety concerns. In patients with a reduced glomerular filtration rate, the risk of nitrofurantoin accumulation and toxicity increases, which can lead to serious adverse effects, including pulmonary and hepatotoxicity. Additionally, nitrofurantoin may be ineffective at lower levels of renal function.

As a result, changing nitrofurantoin to an alternative agent is the most appropriate action before discharging a patient with chronic kidney disease. This ensures that the patient receives a safe and effective antibiotic that is less dependent on renal clearance, thereby reducing the risk of potential side effects and enhancing therapeutic outcomes.

Continuing current therapy, reducing the dose, or counseling about neuropathy would not adequately address the risks associated with nitrofurantoin in a patient with compromised renal function. Changing to a safer alternative is crucial for the patient’s well-being and effective treatment.