Pyelonephritis medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Medical Therapy
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 maximise urine output.
In recurrent infections, additional investigations may identify an underlying abnormality. Occasionally, surgical intervention is necessary to improve chances of recurrence. If no abnormality is identified, some studies suggest long-term preventative (prophylactic) treatment with antibiotics, either daily or after sexual intercourse.[1] In children at risk of recurrent UTIs, the evidence is inconclusive as to whether long-term prophylactic antibiotics are of use.[2] Ingestion of cranberry juice has been studied as a prophylactic measure; while studies are heterogeneous, many suggest a benefit.[3]
References
- ↑ Schooff M, Hill K (2005). "Antibiotics for recurrent urinary tract infections". American family physician. 71 (7): 1301–2. PMID 15832532.
- ↑ Williams GJ, Wei L, Lee A, Craig JC (2006). "Long-term antibiotics for preventing recurrent urinary tract infection in children". Cochrane database of systematic reviews (Online). 3: CD001534. doi:10.1002/14651858.CD001534.pub2. PMID 16855971.
- ↑ Raz R, Chazan B, Dan M (2004). "Cranberry juice and urinary tract infection". Clin. Infect. Dis. 38 (10): 1413–9. doi:10.1086/386328. PMID 15156480.