Which anti-infective is listed as potentially inappropriate for older adults?

• A. Doxycycline
• B. Nitrofurantoin
• C. Amoxicillin
• D. Azithromycin

Answer: (B)

The main idea is that the Beers Criteria flags certain anti-infectives for older adults because of safety concerns unique to aging. Nitrofurantoin is listed as potentially inappropriate because many older adults have reduced kidney function, and nitrofurantoin relies on adequate renal clearance to reach safe, effective urinary levels.

With diminished renal function, nitrofurantoin can fail to treat urinary infections effectively and, more importantly, can lead to systemic exposure that increases the risk of serious adverse effects such as pulmonary toxicity (acute or chronic lung reactions), liver toxicity, and peripheral neuropathy. Because these risks are higher in older adults, nitrofurantoin is considered potentially inappropriate in this population.

The other antibiotics listed aren’t broadly categorized as PIM in the Beers Criteria for older adults; they may require cautious use or dose adjustments in certain situations, but they don’t carry the same blanket warning as nitrofurantoin in this context.