Perinephric abscess

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: :Abdurahman Khalil, M.D. [2]

  • For perinephric abscess associated with bacteremia (staphylococcus is the causative organism):
Perinephric Abscess+ Bacteremia
Drainage and Aspiration
MSSA
Nafcillin 2 gm IV q4h
OR
Oxacillin 2 gm IV q4h
OR
Cefazolin 2 gm IV q8h
MRSA
▸ IV Vancomycin15-20 mg/kg q8-12h


  • If Enterobacteriaceae is the causative pathogen(associated with pyelonephritis), treatment regimen will be the same as complicated pyelonephritis after abscess drainage and surgical or image guided aspiration.
Perinephric Abscess+Complicated Pyelonephritis
Preferred Regimen(2-3 weeks)+drainage and aspiration
Ampicillin-gentamicin 150–200 mg/kg IV/day-MDD: 2 mg per kg load, then 1.7 mg per kg q8h or OD: 5.1 (7 if critically ill) mg/kg q24h
OR
Piperacillin-tazobactam 3.375 gm IV 6h
OR
Ticarcillin-clavulanate 3.1 gm IV q6h
OR
Carbapenems:
Doripenem 500 mg IV q8h (1 hr infusion for 10 days)
OR
Imipenem 0.5 gm IV q12h (max 4 gm/day
OR
Meropenem 1 gm IV q8h
Alternative Regimen(2-3 weeks)+drainage and aspiration
▸ IV Fluoroquinolones:
Ciprofloxacin 400 mg IV q12h
OR
Levofloxacin 750 mg IV/po x 5 days
OR
Gatifloxacin 400 mg IV q24h

OR
Ceftazidime 2 gm IV q8h
OR
Cefepime 2 gm IV q12h

†Switch to oral fluoroquinolone or TMP-SMX when possible.