Template:Pyelonephritis antibiotics: Difference between revisions
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(Add pediatric outpatient dosing section with oral cephalosporins and TMP/SMX) |
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===Outpatient=== | ''Treatment is targeted at [[E. coli]], [[Enterococcus]], [[Klebsiella]], [[Proteus mirabilis]], [[S. saprophyticus]].'' | ||
====Outpatient==== | |||
''Consider one dose of [[Ceftriaxone]] 1g IV or [[Gentamicin]] 7mg/kg IV if the regional susceptibility of [[TMP/SMX]] or [[Fluoroquinolones]] is <80%'' | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Ciprofloxacin|dose=500mg PO BID x7 days|context=Outpatient}} '''OR''' | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Trimethoprim-Sulfamethoxazole DS|dose=160/800mg PO BID x14 days|context=Outpatient}} '''OR'''<ref>Gupta K, Hooton TM, Naber KG, et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women. Clinical Infectious Diseases. 2011;52(5):e103-e120. doi:10.1093/cid/ciq257</ref> | |||
===Inpatient Options=== | *{{AntibioticDose|disease=Pyelonephritis|drug=Cephalexin|dose=500mg QID PO x 10-14 days (OR consider 1000mg BID)|context=Outpatient}} '''OR''' | ||
* | *{{AntibioticDose|disease=Pyelonephritis|drug=Cefdinir|dose=300mg BID PO x 10-14 days|context=Outpatient}} '''OR''' | ||
* | *{{AntibioticDose|disease=Pyelonephritis|drug=Cefpodoxime|dose=200mg PO BID x 10 days|context=Outpatient}} '''OR'''<ref>Colgan R, Williams M. Diagnosis and treatment of acute uncomplicated cystitis. Am Fam Physician. 2011 Oct 1;84(7):771-6.</ref> | ||
*Cefotaxime 1-2gm IV q8hr OR | *{{AntibioticDose|disease=Pyelonephritis|drug=Cefixime|dose=400mg PO daily x 10 days|context=Outpatient}} '''OR'''<ref>Acute Pyelonephritis in Adults. Johnson, JR and Russo, TA. New England Journal of Medicine 2018; 378:48-59.</ref> | ||
* | *{{AntibioticDose|disease=Pyelonephritis|drug=Levofloxacin|dose=750mg PO QD x7 days|context=Outpatient}}<ref>Sandberg T. et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012 Aug 4;380(9840):484-90.</ref> | ||
* | ====Adult Inpatient Options==== | ||
* | *{{AntibioticDose|disease=Pyelonephritis|drug=Ciprofloxacin|dose=400mg IV q12hr|context=Adult Inpatient}} '''OR''' | ||
* | *{{AntibioticDose|disease=Pyelonephritis|drug=Ceftriaxone|dose=1gm IV QD|context=Adult Inpatient}} <span style="color:red">'''(Preferred in pregnancy)'''</span> '''OR''' | ||
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefotaxime|dose=1-2gm IV q8hr|context=Adult Inpatient}} '''OR''' | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Gentamicin|dose=3mg/kg/day divided q8hr|context=Adult Inpatient}} +/- [[ampicillin]] 1–2 gm q4hr '''OR''' | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Piperacillin/Tazobactam|dose=3.375 gm IV q6hr|context=Adult Inpatient}} '''OR''' | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefepime|dose=2gm IV q8hr|context=Adult Inpatient}} '''OR''' | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Imipenem/Cilastatin|dose=500mg IV q8hr|context=Adult Inpatient}} | |||
====Pediatric Outpatient Options==== | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Cephalexin|dose=25-50mg/kg/day PO divided q6-8h x 10-14 days (max 500mg/dose)|context=Pediatric Outpatient|population=Pediatric}} '''OR''' | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefixime|dose=8mg/kg PO daily x 10-14 days (max 400mg)|context=Pediatric Outpatient|population=Pediatric}} '''OR''' | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefdinir|dose=14mg/kg/day PO divided BID x 10 days (max 600mg/day)|context=Pediatric Outpatient|population=Pediatric}} '''OR''' | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefpodoxime|dose=10mg/kg/day PO divided BID x 10 days (max 200mg/dose)|context=Pediatric Outpatient|population=Pediatric}} '''OR''' | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Trimethoprim-Sulfamethoxazole DS|display=TMP/SMX|dose=6-12mg/kg/day (TMP) PO divided BID x 10-14 days|context=Pediatric Outpatient|population=Pediatric}} | |||
====Pediatric Inpatient Options==== | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Ceftriaxone|dose=75mg/kg IV QD|context=Pediatric Inpatient|population=Pediatric}} '''OR''' | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefotaxime|dose=50mg/kg IV q8hrs|context=Pediatric Inpatient|population=Pediatric}} '''OR''' | |||
*{{AntibioticDose|disease=Pyelonephritis|drug=Ampicillin|dose=25mg/kg IV q6hrs|context=Pediatric Inpatient|population=Pediatric}} '''+''' {{AntibioticDose|disease=Pyelonephritis|drug=Gentamicin|dose=2.5mg/kg IV q8hrs|context=Pediatric Inpatient|population=Pediatric|link=no}} | |||
*{{AntibioticDose|drug=Ampicillin/Sulbactam|dose=3g IM/IV q6 hours x 14 days|context=UTI, Pyelonephritis|disease=Pyelonephritis|population=Adult}} | |||
Latest revision as of 12:55, 20 March 2026
Treatment is targeted at E. coli, Enterococcus, Klebsiella, Proteus mirabilis, S. saprophyticus.
Outpatient
Consider one dose of Ceftriaxone 1g IV or Gentamicin 7mg/kg IV if the regional susceptibility of TMP/SMX or Fluoroquinolones is <80%
- Ciprofloxacin 500mg PO BID x7 days OR
- Trimethoprim-Sulfamethoxazole DS 160/800mg PO BID x14 days OR[1]
- Cephalexin 500mg QID PO x 10-14 days (OR consider 1000mg BID) OR
- Cefdinir 300mg BID PO x 10-14 days OR
- Cefpodoxime 200mg PO BID x 10 days OR[2]
- Cefixime 400mg PO daily x 10 days OR[3]
- Levofloxacin 750mg PO QD x7 days[4]
Adult Inpatient Options
- Ciprofloxacin 400mg IV q12hr OR
- Ceftriaxone 1gm IV QD (Preferred in pregnancy) OR
- Cefotaxime 1-2gm IV q8hr OR
- Gentamicin 3mg/kg/day divided q8hr +/- ampicillin 1–2 gm q4hr OR
- Piperacillin/Tazobactam 3.375 gm IV q6hr OR
- Cefepime 2gm IV q8hr OR
- Imipenem/Cilastatin 500mg IV q8hr
Pediatric Outpatient Options
- Cephalexin 25-50mg/kg/day PO divided q6-8h x 10-14 days (max 500mg/dose) OR
- Cefixime 8mg/kg PO daily x 10-14 days (max 400mg) OR
- Cefdinir 14mg/kg/day PO divided BID x 10 days (max 600mg/day) OR
- Cefpodoxime 10mg/kg/day PO divided BID x 10 days (max 200mg/dose) OR
- TMP/SMX 6-12mg/kg/day (TMP) PO divided BID x 10-14 days
Pediatric Inpatient Options
- Ceftriaxone 75mg/kg IV QD OR
- Cefotaxime 50mg/kg IV q8hrs OR
- Ampicillin 25mg/kg IV q6hrs + 2.5mg/kg IV q8hrs
- Ampicillin/Sulbactam 3g IM/IV q6 hours x 14 days
- ↑ Gupta K, Hooton TM, Naber KG, et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women. Clinical Infectious Diseases. 2011;52(5):e103-e120. doi:10.1093/cid/ciq257
- ↑ Colgan R, Williams M. Diagnosis and treatment of acute uncomplicated cystitis. Am Fam Physician. 2011 Oct 1;84(7):771-6.
- ↑ Acute Pyelonephritis in Adults. Johnson, JR and Russo, TA. New England Journal of Medicine 2018; 378:48-59.
- ↑ Sandberg T. et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012 Aug 4;380(9840):484-90.