Pyelonephritis medical therapy
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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.
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‡If the pathogen resistance in the community >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 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 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.
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‡Treat IV until 24-48 patient afebrile, then start 2 weeks course of PO regimen in the above table.