Selecting a Treatment Regimen
Acute Pyelonephritis
Recommendations
ÎÎIn patients suspected of pyelonephritis, a urine culture and
susceptibility testing should always be performed, and initial
empiric therapy should be tailored appropriately based on the
infecting uropathogen (A-III).
ÎOral ciprofloxacin 500 mg bid for 7 days with or without an
Î
initial 400 mg dose of IV ciprofloxacin is an appropriate choice
for therapy in patients not requiring hospitalization where
the prevalence of resistance of community uropathogens to
fluoroquinolones is not known to exceed 10% (A-I).
ÎÎIf an initial one-time IV agent is utilized, a long-acting
antimicrobial such as 1 g ceftriaxone or a consolidated
24-hour dose of an aminoglycoside could be used in lieu of
an IV fluoroquinolone (B-III).
ÎÎIf the prevalence of fluoroquinolone resistance is thought
to exceed 10%, an initial one-time IV dose of a long-acting
parenteral antimicrobial such as 1 g ceftriaxone (B-III)
or a consolidated 24-hour dose of an aminoglycoside is
recommended (B-III).
>> Note: Data are insufficient to make a recommendation about what fluoroquinolone
resistance level requires an alternative agent in conjunction with or to replace a
fluoroquinolone for treatment of pyelonephritis.
ÎÎA once-daily oral fluoroquinolone, including ciprofloxacin
1000 mg extended release for 7 days or levofloxacin 750 mg
for 5 days, is an appropriate choice for therapy in patients not
requiring hospitalization where the prevalence of resistance of
community uropathogens is not known to exceed 10% (B-II).
