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{{Pyelonephritis}}
{{CMG}}; {{AE}} {{AK}}


==Empiric Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Clin Infect Dis. 2011;52(5):e103-20.''<ref name="Gupta-2011">{{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="background: #FFFFFF;"
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{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
{| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
! 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}}
! 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}}
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg PO q12h for 7 days'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg PO q12h x 7 days''''' ± '''''[[Ciprofloxacin]] 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'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS <SMALL> '''''(if fluoroquinolone resistance >10%)''''' </SMALL>
|-
| 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'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 1'''''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | WITH OR WITHOUT
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 160/800 mg PO q12h x 14 days'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS <SMALL> '''''(if TMP/SMZ resistance unknown)'''''</SMALL>
|-
| 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'''''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''[[Ciprofloxacin]] 400 mg IV x 1 dose'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 2'''''
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
| 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'''''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 1000 mg PO q24h for 7 days'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg PO q24h for 5 days'''''<BR> OR <BR> ▸ '''''[[TMP/SMZ]] 160/800 mg PO q12h for 14 days '''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | <SMALL>If FQ resistance >10%, add 1 IV dose of '''''[[Ceftriaxone]] 1 g''''' OR '''''[[Gentamicin]] 5–7 mg/kg'''''</SMALL>
| 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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| valign=top |
 
 
 
{| style="background: #FFFFFF;"
{| style="background: #FFFFFF;"
| valign=top |
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
{| style="float: left; cellpadding=0; cellspacing= 0; width: 500px;"
! 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}}
! 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}}
|-
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 500 mg PO q12h for 7 days'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg IV q24h'''''
|-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | WITH OR WITHOUT|-| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 400 mg IV x 1 dose'''''|-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" 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'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 2'''''
|-
| 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'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | WITH OR WITHOUT
|-
| 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'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen 3'''''
|-
| 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
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL> Antibiotics should be administered for at least 10–14 days based on local resistance pattern. <BR> Switch to oral formulations 24–48 hours after fever resolution may be considered. </SMALL>
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ciprofloxacin]] 1000 mg PO q24h for 7 days'''''<BR> OR <BR> ▸ '''''[[Levofloxacin]] 750 mg PO q24h for 5 days'''''<BR> OR <BR> ▸ '''''[[TMP/SMZ]] 160/800 mg PO q12h for 14 days '''''|-| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | <SMALL>If FQ resistance >10%, add 1 IV dose of '''''[[Ceftriaxone]] 1 g''''' OR '''''[[Gentamicin]] 5–7 mg/kg'''''</SMALL>|-
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==References==
{{reflist|2}}

Latest revision as of 02:30, 23 February 2014

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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]

Empiric Therapy Adapted from Clin Infect Dis. 2011;52(5):e103-20.[1]

Acute Pyelonephritis, Outpatient
Preferred Regimen
Ciprofloxacin 500 mg PO q12h x 7 days ± Ciprofloxacin 400 mg IV x 1 dose
OR
Ciprofloxacin XR 1000 mg PO q24h for 7 days
OR
Levofloxacin 750 mg PO q24h for 5 days
PLUS (if fluoroquinolone resistance >10%)
Ceftriaxone 1 g IV x 1 dose
OR
Gentamicin 7 mg/kg IV x 1 dose
OR
Tobramycin 7 mg/kg IV x 1 dose
OR
Amikacin 20 mg/kg IV x 1 dose
Alternative Regimen 1
TMP/SMZ 160/800 mg PO q12h x 14 days
PLUS (if TMP/SMZ resistance unknown)
Ceftriaxone 1 g IV x 1 dose
OR
Gentamicin 7 mg/kg IV x 1 dose
OR
Tobramycin 7 mg/kg IV x 1 dose
OR
Amikacin 20 mg/kg IV x 1 dose
Alternative Regimen 2
Amoxicillin–Clavulanate 500/125 mg PO q12h x 14 days
OR
Amoxicillin–Clavulanate 250/125 mg PO q8h x 5–7 days
OR
Cefaclor 500 mg PO q8h x 7 days
PLUS
Ceftriaxone 1 g IV x 1 dose
OR
Gentamicin 7 mg/kg IV x 1 dose
OR
Tobramycin 7 mg/kg IV x 1 dose
OR
Amikacin 20 mg/kg IV x 1 dose
Acute Pyelonephritis, Inpatient
Preferred Regimen
Ciprofloxacin 400 mg IV q12h
OR
Levofloxacin 750 mg IV q24h
Alternative Regimen 1
Gentamicin 7 mg/kg IV q24h ± Ampicillin 500 mg IV q6h
OR
Tobramycin 7 mg/kg IV q24h ± Ampicillin 500 mg IV q6h
OR
Amikacin 20 mg/kg IV q24h ± Ampicillin 500 mg IV q6h
Alternative Regimen 2
Cefotaxime 1–2 gm IV q8h
OR
Ceftriaxone 1 gm IV q24h
OR
Ceftazidime 2 gm IV q8h
OR
Ampicillin-Sulbactam 1.5 g IV q6h
OR
Piperacillin-Tazobactam 3.375 gm IV q4–6h
OR
Ticarcillin-Clavulanate 3.1 gm IV q4–6h
WITH OR WITHOUT
Gentamicin 7 mg/kg IV q24h
OR
Tobramycin 7 mg/kg IV q24h
OR
Amikacin 20 mg/kg IV q24h
Alternative Regimen 3
Meropenem 500 mg IV q8h
OR
Ertapenem 1 g IV q24h
OR
Doripenem 500 mg IV q8h
OR
Aztreonam 1 g IV q8–12h
Antibiotics should be administered for at least 10–14 days based on local resistance pattern.
Switch to oral formulations 24–48 hours after fever resolution may be considered.


References

  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)