Pyelonephritis medical therapy
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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 Pyelonephritis Medical Therapy
- 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.
Uncomplicated pyelonephritis
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- It's optional to initiate oral fluoroquinolones therapy with 400 mg IV ciprofloxacin
- If the pathogen resistance to fluoroquinolones in the community is >10% or unknown, it's recommended to start an initial one-time intravenous dose of a long-acting parenteral antimicrobials like 1 g of ceftriaxone or a consolidated 24-h dose of an aminoglycoside.
- If the pathogen susceptibility to TMP-SMX is unknown, It's recommended to begin with an initial one-time intravenous dose of a long-acting parenteral antimicrobials like 1 g of ceftriaxone or a consolidated 24-h dose of an aminoglycoside.
- It's recommended to begin beta-lactams regimen with an initial one-time intravenous dose of a long-acting parenteral antimicrobials like 1 g of ceftriaxone or a consolidated 24-h dose of an aminoglycoside.
Hospitalized patients
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]
Intravenous antimicrobials should be used based on susceptibility resullts and local resistance data.
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‡Treat IV until 24-48 patient afebrile, then start 2 weeks course of PO regimen in the first table(uncomplicated pyelonephritis).
- Treat with ampicillin-sulbactam with or without an aminoglycoside if a gram positive cocci is the casitive organism.[2]
Complicated pyelonephritis
All men considered as complicated infection, others include pregnant women and children with metabolic or anatomical abnoramlities, as a general rule all patients with risk of serious complications and/or failure of treatment(stones, obstruction, immunocompromised patients, neurogenic bladder, renal failure,transplant patients) considered as complicated infections.[3]
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†Switch to oral fluoroquinolone or TMP-SMX when is possible.
References
- ↑ 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
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ignored (help) - ↑ 2.0 2.1 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
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ignored (help) - ↑ Hooton, TM. (2012). "Clinical practice. Uncomplicated urinary tract infection". N Engl J Med. 366 (11): 1028–37. doi:10.1056/NEJMcp1104429. PMID 22417256. Unknown parameter
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ignored (help)