Sandbox/pyelo

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

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 are generally administered for at least 10–14 days. The choice of agents should be based on local resistance pattern. Switch to oral formulations 24–48 hours after fever resolution may be considered.