Template:Pyelonephritis antibiotics
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.