Pyelonephritis medical therapy: Difference between revisions
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluoroquinolones]]''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluoroquinolones]]'''''<br>'''''[[Ciprofloxacin]] 500 mg PO bid ×7 days<br>[[Levofloxacin]] 750 mg PO q24 × 5 days<br>[[Ofloxacin]] 400 mg Po bid<br>[[Moxifloxacin]] 400 mg PO q24h''''' | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen(14 day regimen)'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen(14 day regimen)'' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP-SMX]] | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP-SMX]] 160/800 mg PO bid'''''<br>OR<br>'''''▸ Oral[[β-lactam]]<br>[[Amoxicillin-clavulanate]] 875/125 mg po q12h or 500/125 mg po tid or 1000 /125 mg po bid <br>[[Cefdinir]] 300 mg po q12h or 600 mg po q24 <br>[[Cefaclor]] 250-500 mg po q8h<br>[[Cefpodoxime-proxetil]] 100-200 mg po q12h<br>[[Cephalexin]]250-500 mg po q6h not studied well but effective.''''' | ||
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*If the pathogen resistance to [[fluoroquinolones]] in the community is >10% or unknown, it's recommended to start an initial one-time intravenous dose of a long-acting parenteral antimicrobials like 1 g of [[ceftriaxone]] or a consolidated 24-h dose of an [[aminoglycoside]].<br> | |||
*If the pathogen susceptibility to {{TMP_SMX]] is unknown, It's recommended to begin with an initial one-time intravenous dose of a long-acting parenteral antimicrobials like 1 g of [[ceftriaxone]] or a consolidated 24-h dose of an [[aminoglycoside]].<br> | |||
*It's recommended to begin beta-lactams regimen with an initial one-time intravenous dose of a long-acting parenteral antimicrobials like 1 g of [[ceftriaxone]] or a consolidated 24-h dose of an [[aminoglycoside]].<br> | |||
*It's optional to initiate oral [[fluoroquinolones]] therapy with 400 mg IV [[ciprofloxacin]] | *It's optional to initiate oral [[fluoroquinolones]] therapy with 400 mg IV [[ciprofloxacin]] | ||
As practically all cases of pyelonephritis are due to bacterial infections, [[antibiotic]]s are the mainstay of treatment. Mild cases may be treated with oral therapy, but generally [[intravenous]] antibiotics are required for the initial stages of treatment. The type of antibiotic depends on local practice, and may include [[fluoroquinolone]]s (e.g. [[ciprofloxacin]]), [[beta-lactam antibiotic]]s (e.g. [[amoxicillin]] or a [[cephalosporin]]), [[trimethoprim]] (or [[co-trimoxazole]]) or [[nitrofurantoin]]. [[Aminoglycoside]]s are avoided due to their toxicity, but may be added for a short duration. | As practically all cases of pyelonephritis are due to bacterial infections, [[antibiotic]]s are the mainstay of treatment. Mild cases may be treated with oral therapy, but generally [[intravenous]] antibiotics are required for the initial stages of treatment. The type of antibiotic depends on local practice, and may include [[fluoroquinolone]]s (e.g. [[ciprofloxacin]]), [[beta-lactam antibiotic]]s (e.g. [[amoxicillin]] or a [[cephalosporin]]), [[trimethoprim]] (or [[co-trimoxazole]]) or [[nitrofurantoin]]. [[Aminoglycoside]]s are avoided due to their toxicity, but may be added for a short duration. |
Revision as of 20:57, 20 January 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief:
Medical Therapy
- Before starting treatment for suspected pyelonephritis, a urine culture and susceptibility test should be done in order to select the empirical antimicrobial that covers the causing organism.
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- If the pathogen resistance to fluoroquinolones in the community is >10% or unknown, it's recommended to start an initial one-time intravenous dose of a long-acting parenteral antimicrobials like 1 g of ceftriaxone or a consolidated 24-h dose of an aminoglycoside.
- If the pathogen susceptibility to {{TMP_SMX]] is unknown, It's recommended to begin with an initial one-time intravenous dose of a long-acting parenteral antimicrobials like 1 g of ceftriaxone or a consolidated 24-h dose of an aminoglycoside.
- It's recommended to begin beta-lactams regimen with an initial one-time intravenous dose of a long-acting parenteral antimicrobials like 1 g of ceftriaxone or a consolidated 24-h dose of an aminoglycoside.
- It's optional to initiate oral fluoroquinolones therapy with 400 mg IV ciprofloxacin
As practically all cases of pyelonephritis are due to bacterial infections, antibiotics are the mainstay of treatment. Mild cases may be treated with oral therapy, but generally intravenous antibiotics are required for the initial stages of treatment. The type of antibiotic depends on local practice, and may include fluoroquinolones (e.g. ciprofloxacin), beta-lactam antibiotics (e.g. amoxicillin or a cephalosporin), trimethoprim (or co-trimoxazole) or nitrofurantoin. Aminoglycosides are avoided due to their toxicity, but may be added for a short duration.
If the patient is unwell and septic, intravenous fluids may be administered to compensate for the reduced oral intake, insensible losses (due to the raised temperature) and vasodilation and to maximize urine output.
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‡Treat IV until 24-48 patient afebrile, then start 2 weeks course of PO regimen in the above table.