From the FDA Drug Label
Ciprofloxacin is indicated for the treatment of complicated urinary tract infections and pyelonephritis due to Escherichia coli
Ciprofloxacin can be used for the treatment of complicated urinary tract infections and pyelonephritis. However, renal abscess is not explicitly mentioned in the label. Since the label does mention pyelonephritis, which can be associated with renal abscess, but does not directly address renal abscess, a conservative clinical decision would be to consult other resources for the most appropriate treatment. 1
From the Research
For a renal abscess, empiric antibiotic therapy should initially include broad-spectrum coverage with intravenous antibiotics, and drainage of the abscess is often necessary alongside antibiotics, either percutaneously or surgically for larger abscesses (>5cm) as shown in the study by 2. The choice of antibiotics should be based on the severity of the infection and the potential pathogens involved.
- A combination of a third-generation cephalosporin (ceftriaxone 1-2g IV every 24 hours) plus an anti-anaerobic agent (metronidazole 500mg IV every 8 hours) can be used.
- Alternatively, a fluoroquinolone (ciprofloxacin 400mg IV every 12 hours) plus metronidazole, or piperacillin-tazobactam (3.375g IV every 6 hours) or a carbapenem like meropenem (1g IV every 8 hours) can be used as monotherapy. The study by 2 showed that all 49 patients with renal abscesses measuring 5 cm or less were treated successfully with intravenous antibiotics alone, with complete clinical regression and resolution of the renal lesions. However, the study by 3 suggested that large abscesses often require more than one percutaneous drainage procedure or adjunct open surgical intervention. The treatment approach should be individualized based on the size of the abscess, the patient's overall health, and the presence of any underlying conditions, as shown in the study by 4. Antibiotic therapy should be adjusted based on culture results from blood or abscess fluid to target the specific pathogens, which commonly include E. coli, Klebsiella, Proteus, Staphylococcus, or Streptococcus species, as shown in the study by 5. The study by 6 also suggested that the medium-sized renal abscesses may be solved using a percutaneous abscess punction, and the small-sized abscesses may be successfully solved using antibiotics, introduced parenterally.