Pyelonephritis medical therapy: Difference between revisions
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‡Treat IV until 24-48 patient afebrile, then start 2 weeks course of PO regimen in the above table. | ‡Treat IV until 24-48 patient afebrile, then start 2 weeks course of PO regimen in the above table. | ||
===Complicated | ===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.{{Cite journal | last1 = Hooton | first1 = TM. | title = Clinical practice. Uncomplicated urinary tract infection. | journal = N Engl J Med | volume = 366 | issue = 11 | pages = 1028-37 | month = Mar | year = 2012 | doi = 10.1056/NEJMcp1104429 | PMID = 22417256 }} | 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.{{Cite journal | last1 = Hooton | first1 = TM. | title = Clinical practice. Uncomplicated urinary tract infection. | journal = N Engl J Med | volume = 366 | issue = 11 | pages = 1028-37 | month = Mar | year = 2012 | doi = 10.1056/NEJMcp1104429 | PMID = 22417256 }} | ||
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{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:25em" cellpadding="0" cellspacing="0"; | {| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:25em" cellpadding="0" cellspacing="0"; | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B| Complicated | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B| Complicated nephritis}}'' | ||
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! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen(2-3 weeks)''† | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen(2-3 weeks)''† |
Revision as of 20:05, 22 January 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief:
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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- 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.
- It's optional to initiate oral fluoroquinolones therapy with 400 mg IV ciprofloxacin
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 maximize urine output.
Hospitalized patients
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 above table.
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.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 |month=
ignored (help)
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