Pyelonephritis medical therapy

Urinary Tract Infections Main Page
Pyelonephritis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Pyelonephritis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocaridogram
X Ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Interventions
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Pyelonephritis medical therapy On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Pyelonephritis medical therapy All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Pyelonephritis medical therapy
CDC on Pyelonephritis medical therapy
Pyelonephritis medical therapy in the news
Blogs on Pyelonephritis medical therapy
Directions to Hospitals Treating Pyelonephritis
Risk calculators and risk factors for Pyelonephritis medical therapy

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.

Acute Bacterial Uncomplicated Pyelonephritis Preferred Regimen ▸ Fluoroquinolones Ciprofloxacin 500 mg PO bid ×7 days Levofloxacin 750 mg PO q24 × 5 days Ofloxacin 400 mg Po bid Moxifloxacin 400 mg PO q24h Alternative Regimen(14 day regimen) ▸ TMP-SMX† 160/800 mg PO bid OR ▸ Oralβ-lactam† Amoxicillin-clavulanate 875/125 mg po q12h or 500/125 mg po tid or 1000 /125 mg po bid Cefdinir 300 mg po q12h or 600 mg po q24 Cefaclor 250-500 mg po q8h Cefpodoxime-proxetil 100-200 mg po q12h Cephalexin250-500 mg po q6h not studied well but effective.

†It's optional to begin with an initial intravenous dose of a long-acting parenteral antimicrobial, such like 400 mg dose of ciprofloxacin, other choicees are 1 g of ceftriaxone or a consolidated 24-h dose of an aminoglycoside.

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.

Acute Pyelonephritis-Hospitaliztion Preferred Regimen(14 days)‡ ▸ IV Fluoroquinolones Ciprofloxacin400 mg IV q12h Levofloxacin 750 mg IV q24h; Gatifloxacin 400 mg IV q24h OR ▸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 ▸Ceftriaxone 1-2 gm IV q24h OR ▸Piperacillin-tazobactam 3.375 gm IV q4-6h Alternative Regimen(14 day)‡ ▸ Ticarcillin-clavulanate 3.1 gm IV q6h OR ▸Ampicillin-sulbactam 3 gm IV q6h OR ▸Piperacillin-tazobactam 3.375 gm IV q4-6h OR ▸Ertapenem 31 gm IV q24h OR ▸Doripenem 500 mg IV q8h (1 hr infusion for 10 days)

‡Treat IV until 24-48 patient afebrile, then start 2 weeks course of PO regimen in the above table.