Renal Dose Adjustment — ORE Part 1 MCQ
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Correct answer: B — Amoxicillin
Amoxicillin is a renally cleared β-lactam antibiotic that accumulates in severe renal impairment. For CKD stage 5 (eGFR <15), standard guidance recommends dose reduction: 250 mg 8-hourly or 500 mg 12-hourly, compared to normal 500 mg 8-hourly. This is essential to avoid toxicity and achieve therapeutic drug concentrations. Paracetamol is hepatically metabolised with minimal renal excretion and requires no adjustment. Lidocaine and articaine are local anaesthetics metabolised hepatically (lidocaine) or by plasma esterases (articaine) and are not contraindicated at standard dental doses. Chlorhexidine is a topical antimicrobial with negligible systemic absorption and does not accumulate renally. Thus amoxicillin is the only commonly prescribed dental drug in this list requiring documented dose adjustment for CKD stage 5.
Reference: Derby & Burton NHS Trust High Dose Antimicrobial Guideline (2024), Section on Amoxicillin Renal Dosing: https://www.dbth.nhs.uk/wp-content/uploads/2024/06/High-dose-antibiotic-guideline-2024-FINAL.pdf