Pyelonephritis medical therapy: Difference between revisions
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*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. | *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. | ||
*When the patient fails to response to oral out patient treatment, or shows signs of severe illness/sepsis like high fever, high WBC, nausa or vomiting, dehydration; it's required to change to inpatient treatment, [[intravenous fluid]]s may be administered to compensate for the reduced oral intake, insensible losses (due to the raised temperature) and [[vasodilation]] and to maximize urine output.<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> | |||
== Empiric Therapy== | == Empiric Therapy== | ||
Revision as of 17:45, 22 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]
Overview
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 acephalosporin), trimethoprim (or co-trimoxazole) or nitrofurantoin. Aminoglycosides are avoided due to their toxicity, but may be added for a short duration.[1]
Principles of therapy for pyelonephritis
- 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.
- When the patient fails to response to oral out patient treatment, or shows signs of severe illness/sepsis like high fever, high WBC, nausa or vomiting, dehydration; it's required to change to inpatient treatment, 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.[2]
Empiric Therapy
Acute Pyelonephritis, Outpatient |
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Preferred Regimen |
▸ Ciprofloxacin 500 mg PO q12h for 7 days |
WITH OR WITHOUT |
▸ Ciprofloxacin 400 mg IV x 1 dose |
Alternative Regimen |
▸ Ciprofloxacin 1000 mg PO q24h for 7 days OR ▸ Levofloxacin 750 mg PO q24h for 5 days OR ▸ TMP/SMZ 160/800 mg PO q12h for 14 days |
If FQ resistance >10% or unknown resistance to TMP-SMX, add 1 IV dose ofCeftriaxone 1 g OR Gentamicin 5–7 mg/kg.[1]
|
Acute Pyelonephritis, Inpatient |
---|
Preferred Regimen |
▸ Ciprofloxacin 400 mg IV q12h OR ▸Levofloxacin 750 mg IV q24h OR ▸ Gentamicin 5–7 mg/kg IV q24h OR ▸ Ceftriaxone 1–2 gm IV q24h OR ▸ Cefotaxime 2 gm IV q8h OR ▸ Piperacillin/Tazobactam 3.375 gm IV q4–6h OR ▸ Ertapenem 1 gm IV q24h OR ▸ Doripenem 500 mg IV q8h |
Switch to PO 24-48 hr after fever resolution. The choice of antiobiotics should be based on resistance pattern.[1]
|
References
- ↑ 1.0 1.1 1.2 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)