Selecting a Treatment Regimen Acute Pyelonephritis
ÎIn 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 for 7 days with or without an
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).
ÎIf 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).
ÎIf 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.
ÎA 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).
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