ÎÎTMP-SMX DS bid for 14 days is an appropriate choice for
therapy if the uropathogen is known to be susceptible (A-I).
If TMP-SMX is used when the susceptibility is not known, an
initial IV dose of a long-acting parenteral antimicrobial such
as 1 g ceftriaxone (B-II) or a consolidated 24-hour dose of an
aminoglycoside is recommended (B-III).
ÎÎOral β-lactam agents are less effective than other available
agents for treatment of pyelonephritis (B-III). If an oral
β-lactam agent is used, an initial IV dose of a long-acting
parenteral antimicrobial such as 1 g ceftriaxone (B-II)
or a consolidated 24-hour dose of an aminoglycoside is
recommended (B-III).
>> Note: Data are insufficient to modify the previous guideline recommendation
for a duration of therapy of 10-14 days for treatment of pyelonephritis with a
β-lactam agent.
ÎÎWomen with pyelonephritis requiring hospitalization should
be initially treated with an IV antimicrobial regimen such
as a fluoroquinolone, an aminoglycoside with or without
ampicillin, an extended-spectrum cephalosporin or extendedspectrum penicillin with or without an aminoglycoside, or
a carbapenem. The choice between these agents should be
based on local resistance data, and the regimen should be
tailored based on susceptibility results (B-III).
