Pyelonephritis medical therapy: Difference between revisions
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* Pregnant women, patients who failed to respond to oral therapy, and patients with [[nausea]], [[vomiting]], high [[fever]], marked [[leukocytosis]], or [[dehydration]] should be hospitalized and managed with parenteral antibiotics.<ref name="Warren-1999">{{Cite journal | last1 = Warren | first1 = JW. | last2 = Abrutyn | first2 = E. | last3 = Hebel | first3 = JR. | last4 = Johnson |first4 = JR. | last5 = Schaeffer | first5 = AJ. | last6 = Stamm | first6 = WE. | title = Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). | journal = Clin Infect Dis | volume = 29 | issue = 4 | pages = 745-58 | month = Oct | year = 1999 | doi = 10.1086/520427 | PMID = 10589881 }}</ref> | * Pregnant women, patients who failed to respond to oral therapy, and patients with [[nausea]], [[vomiting]], high [[fever]], marked [[leukocytosis]], or [[dehydration]] should be hospitalized and managed with parenteral antibiotics.<ref name="Warren-1999">{{Cite journal | last1 = Warren | first1 = JW. | last2 = Abrutyn | first2 = E. | last3 = Hebel | first3 = JR. | last4 = Johnson |first4 = JR. | last5 = Schaeffer | first5 = AJ. | last6 = Stamm | first6 = WE. | title = Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). | journal = Clin Infect Dis | volume = 29 | issue = 4 | pages = 745-58 | month = Oct | year = 1999 | doi = 10.1086/520427 | PMID = 10589881 }}</ref> | ||
{{Pyelonephritis | ==Empiric Therapy for Acute Pyelonephritis (Outpatient & Inpatient) <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Clin Infect Dis. 2011;52(5):e103-20.''<ref name="Gupta-2011"<ref>{{Cite journal | last1 = Gupta | first1 = K. | last2 = Hooton | first2 = TM. | last3 = Naber | first3 = KG. | last4 = Wullt | first4 = B. | last5 = Colgan | first5 = R. | last6 = Miller | first6 = LG. | last7 = Moran | first7 = GJ. | last8 = Nicolle | first8 = LE. | last9 = Raz | first9 = R. | title = International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. | journal = Clin Infect Dis | volume = 52 | issue = 5 | pages = e103-20 | month = Mar | year = 2011 | doi = 10.1093/cid/ciq257 | PMID = 21292654 }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>== | ||
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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Acute Pyelonephritis, Outpatient}} | |||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg PO q12h x 7 days''''' ± '''''400 mg IV x 1 dose''''' <BR> OR <BR> ▸ '''''[[Ciprofloxacin]] XR 1000 mg PO q24h for 7 days'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg PO q24h for 5 days''''' | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS <SMALL> '''''(if fluoroquinolone resistance >10%)''''' </SMALL> | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1 g IV x 1 dose'''''<BR> OR <BR> ▸ '''''[[Gentamicin]] 7 mg/kg IV x 1 dose'''''<BR> OR <BR> ▸ '''''[[Tobramycin]] 7 mg/kg IV x 1 dose'''''<BR> OR <BR> ▸ '''''[[Amikacin]] 20 mg/kg IV x 1 dose''''' | |||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen 1 | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 160/800 mg PO q12h x 14 days''''' | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS <SMALL> '''''(if TMP/SMZ resistance unknown)'''''</SMALL> | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1 g IV x 1 dose'''''<BR> OR <BR> ▸ '''''[[Gentamicin]] 7 mg/kg IV x 1 dose'''''<BR> OR <BR> ▸ '''''[[Tobramycin]] 7 mg/kg IV x 1 dose'''''<BR> OR <BR> ▸ '''''[[Amikacin]] 20 mg/kg IV x 1 dose''''' | |||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen 2 | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amoxicillin-clavulanate potassium|Amoxicillin–Clavulanate]] 500/125 mg PO q12h x 14 days'''''<BR> OR <BR> ▸ '''''[[Amoxicillin-clavulanate potassium|Amoxicillin–Clavulanate]] 250/125 mg PO q8h x 5–7 days'''''<BR> OR <BR> ▸ '''''[[Cefaclor]] 500 mg PO q8h x 7 days''''' | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1 g IV x 1 dose'''''<BR> OR <BR> ▸ '''''[[Gentamicin]] 7 mg/kg IV x 1 dose'''''<BR> OR <BR> ▸ '''''[[Tobramycin]] 7 mg/kg IV x 1 dose'''''<BR> OR <BR> ▸ '''''[[Amikacin]] 20 mg/kg IV x 1 dose''''' | |||
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! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Acute Pyelonephritis, Inpatient}} | |||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg IV q24h''''' | |||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen 1 | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 7 mg/kg IV q24h''''' ± '''''[[Ampicillin]] 500 mg IV q6h'''''<BR> OR <BR> ▸ '''''[[Tobramycin]] 7 mg/kg IV q24h''''' ± '''''[[Ampicillin]] 500 mg IV q6h'''''<BR> OR <BR> ▸ '''''[[Amikacin]] 20 mg/kg IV q24h''''' ± '''''[[Ampicillin]] 500 mg IV q6h''''' | |||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Alternative Regimen 2 | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 1–2 gm IV q8h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 1 gm IV q24h'''''<BR> OR <BR> ▸ '''''[[Ceftazidime]] 2 gm IV q8h'''''<BR> OR <BR> ▸ '''''[[Ampicillin sulbactam|Ampicillin–Sulbactam]] 1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Piperacillin-Tazobactam|Piperacillin–Tazobactam]] 3.375 gm IV q4–6h'''''<BR> OR <BR> ▸ '''''[[Ticarcillin clavulanate|Ticarcillin–Clavulanate]] 3.1 gm IV q4–6h''''' | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | WITH OR WITHOUT | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 7 mg/kg IV q24h'''''<BR> OR <BR> ▸ '''''[[Tobramycin]] 7 mg/kg IV q24h'''''<BR> OR <BR> ▸ '''''[[Amikacin]] 20 mg/kg IV q24h''''' | |||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 3''''' | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 500 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Ertapenem]] 1 g IV q24h'''''<BR> OR <BR> ▸ '''''[[Doripenem]] 500 mg IV q8h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 1 g IV q8–12h''''' | |||
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| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL> '''Antibiotics should be administered for ≥10–14 days based on local resistance patterns.''' <BR> '''De-escalation to oral antibiotics may be considered 24–48 hours after defervescence.''' </SMALL> | |||
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==Empiric Therapy for Acute Pyelonephritis (Pregnancy) <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''European Association of Urology's Guidelines on Urological Infections.''<ref>{{Cite web | last = | first = | title = http://www.uroweb.org/gls/pdf/18_Urological%20infections_LR.pdf | url =http://www.uroweb.org/gls/pdf/18_Urological%20infections_LR.pdf | publisher = | date = | accessdate = }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>== | |||
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|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5; font-weight: bold; font-style: italic;" align=center | Preferred Regimen | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 1–2 g IV/IM q24h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 1 g IV q8–12h'''''<BR> OR <BR> ▸ '''''[[Piperacillin-Tazobactam|Piperacillin–Tazobactam]] 3.375–4.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 1 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Imipenem-Cilastatin|Imipenem–Cilastatin]] 500 mg IV q6h''''' | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | OR | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q6h''''' | |||
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| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 3–5 mg/kg/day IV q8h''''' | |||
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==References== | ==References== |
Revision as of 23:03, 3 June 2014
Pyelonephritis Microchapters |
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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]
Overview
Most cases of pyelonephritis are caused by bacteria. Mild pyelonephritis may be managed with oral antibiotics, and an initial intravenous dose may be administered depending on local resistance patterns. Patients with dehydration, nausea, vomiting, or signs of sepsis should be admitted and receive parenteral therapy. Fluoroquinolones, aminoglycosides, trimethoprim-sulfamethoxazole, carbapenems, and extended-spectrum cephalosporins and penicillins are commonly used in the treatment of acute pyelonephritis.[1]
Principles of Therapy for Acute Pyelonephritis
- Before initiating antimicrobial treatment for suspected pyelonephritis, a urine culture and susceptibility test should always be performed to help tailor empiric therapy.
- Optimal management depends on severity of illness at presentation, local resistance data, and host factors; when local resistance patterns are unknown, an initial intravenous dose of a long-acting, broad-spectrum antimicrobial agent may be considered.
- Oral beta-lactams are less effective than trimethoprim-sulfamethoxazole, fluoroquinolones, or aminoglycosides in eradicating uropathogens.
- Uncomplicated pyelonephritis due to MRSA is uncommon and there is insufficient evidence to support empiric use of an MRSA-active agent.
- Ampicillin should be limited to treating suspected Enterococcus infection and co-administered with an aminoglycoside.
- Fluoroquinolones and aminoglycosides should be avoided in pregnant patients.
- Pregnant women, patients who failed to respond to oral therapy, and patients with nausea, vomiting, high fever, marked leukocytosis, or dehydration should be hospitalized and managed with parenteral antibiotics.[2]
Empiric Therapy for Acute Pyelonephritis (Outpatient & Inpatient) Adapted from Clin Infect Dis. 2011;52(5):e103-20.[1]
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Empiric Therapy for Acute Pyelonephritis (Pregnancy) Adapted from European Association of Urology's Guidelines on Urological Infections.[3]
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References
- ↑ 1.0 1.1 Gupta, K.; Hooton, TM.; Naber, KG.; Wullt, B.; Colgan, R.; Miller, LG.; Moran, GJ.; Nicolle, LE.; Raz, R. (2011). "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clin Infect Dis. 52 (5): e103–20. doi:10.1093/cid/ciq257. PMID 21292654. Unknown parameter
|month=
ignored (help) - ↑ Warren, JW.; Abrutyn, E.; Hebel, JR.; Johnson, JR.; Schaeffer, AJ.; Stamm, WE. (1999). "Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA)". Clin Infect Dis. 29 (4): 745–58. doi:10.1086/520427. PMID 10589881. Unknown parameter
|month=
ignored (help) - ↑ "http://www.uroweb.org/gls/pdf/18_Urological%20infections_LR.pdf" (PDF). External link in
|title=
(help)