Pyelonephritis medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
Most cases of pyelonephritis are caused by bacteria. Mild pyelonephritis may be managed with oral antibiotics, and an initial intravenous dose may be administered depending on local resistance patterns. Patients with [[dehydration]], [[nausea]], [[vomiting]], or signs of [[sepsis]] should be admitted and receive parenteral therapy. [[Fluoroquinolone]]s, [[aminoglycoside]]s, [[TMP/SMZ|trimethoprim-sulfamethoxazole]], [[carbapenem]]s, and extended-spectrum [[cephalosporin]]s and [[penicillins]] are commonly used in the treatment of acute pyelonephritis.<ref name="Gupta-2011">{{Cite journal | last1 = Gupta | first1 = K. | last2 = Hooton | first2 = TM. | last3 = Naber|first3 = KG. | last4 = Wullt | first4 = B. | last5 = Colgan | first5 = R. | last6 = Miller | first6 = LG. | last7 = Moran | first7 = GJ. | last8 = Nicolle | first8 = LE. | last9 = Raz | first9 = R. | title = 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. | journal = Clin Infect Dis | volume = 52 | issue = 5 | pages = e103-20 | month = Mar | year = 2011 | doi = 10.1093/cid/ciq257|PMID = 21292654 }}</ref> | |||
==Principles of Therapy for Acute Pyelonephritis== | ==Principles of Therapy for Acute Pyelonephritis== | ||
* Before initiating antimicrobial treatment for suspected pyelonephritis, a urine culture and susceptibility test should always be performed to help tailor | * Before initiating antimicrobial treatment for suspected pyelonephritis, a urine culture and susceptibility test should always be performed to help tailor empiric therapy. | ||
* Optimal management depends on severity of illness at presentation, local resistance data, and host factors; when local resistance patterns are unknown, an initial intravenous dose of a long-acting, broad-spectrum antimicrobial agent may be considered. | * Optimal management depends on severity of illness at presentation, local resistance data, and host factors; when local resistance patterns are unknown, an initial intravenous dose of a long-acting, broad-spectrum antimicrobial agent may be considered. | ||
* Oral [[beta- | * Oral [[beta-lactam]]s are less effective than [[TMP/SMZ|trimethoprim-sulfamethoxazole]], [[fluoroquinolone]]s, or [[aminoglycosides]] in eradicating uropathogens. | ||
* Uncomplicated pyelonephritis due to [[MRSA]] is uncommon and there is insufficient evidence to support empiric use of an [[ | * Uncomplicated pyelonephritis due to [[MRSA]] is uncommon and there is insufficient evidence to support empiric use of an [[MRSA]]-active agent. | ||
* [[Ampicillin]] should be limited to treating suspected [[Enterococcus]] infection and co-administered | * [[Ampicillin]] should be limited to treating suspected ''[[Enterococcus]]'' infection and co-administered with an [[aminoglycoside]]. | ||
* [[ | * [[Fluoroquinolone]]s and [[aminoglycoside]]s should be avoided in pregnant patients. | ||
* Pregnant women, patients who failed to respond to oral therapy, and patients with [[nausea]], [[vomiting]], high [[fever]], marked [[leukocytosis]], or [[dehydration]] should be hospitalized and managed with parenteral antibiotics.<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> | * Pregnant women, patients who failed to respond to oral therapy, and patients with [[nausea]], [[vomiting]], high [[fever]], marked [[leukocytosis]], or [[dehydration]] should be hospitalized and managed with parenteral antibiotics.<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> |
Revision as of 15:30, 24 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
Most cases of pyelonephritis are caused by bacteria. Mild pyelonephritis may be managed with oral antibiotics, and an initial intravenous dose may be administered depending on local resistance patterns. Patients with dehydration, nausea, vomiting, or signs of sepsis should be admitted and receive parenteral therapy. Fluoroquinolones, aminoglycosides, trimethoprim-sulfamethoxazole, carbapenems, and extended-spectrum cephalosporins and penicillins are commonly used in the treatment of acute pyelonephritis.[1]
Principles of Therapy for Acute Pyelonephritis
- Before initiating antimicrobial treatment for suspected pyelonephritis, a urine culture and susceptibility test should always be performed to help tailor empiric therapy.
- Optimal management depends on severity of illness at presentation, local resistance data, and host factors; when local resistance patterns are unknown, an initial intravenous dose of a long-acting, broad-spectrum antimicrobial agent may be considered.
- Oral beta-lactams are less effective than trimethoprim-sulfamethoxazole, fluoroquinolones, or aminoglycosides in eradicating uropathogens.
- Uncomplicated pyelonephritis due to MRSA is uncommon and there is insufficient evidence to support empiric use of an MRSA-active agent.
- Ampicillin should be limited to treating suspected Enterococcus infection and co-administered with an aminoglycoside.
- Fluoroquinolones and aminoglycosides should be avoided in pregnant patients.
- Pregnant women, patients who failed to respond to oral therapy, and patients with nausea, vomiting, high fever, marked leukocytosis, or dehydration should be hospitalized and managed with parenteral antibiotics.[2]
Empiric Therapy Adapted from Clin Infect Dis. 2011;52(5):e103-20.[1]
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References
- ↑ 1.0 1.1 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)