From the Guidelines
The treatment for a patient with kidney stones and fever requires immediate medical attention with intravenous antibiotics such as ceftriaxone 1-2g daily or ciprofloxacin 400mg twice daily, along with pain control and adequate hydration. The patient's condition suggests a possible urinary tract infection or infected kidney stone (pyelonephritis) 1. Initial management includes:
- Intravenous antibiotics such as ceftriaxone 1-2g daily or ciprofloxacin 400mg twice daily
- Pain control using NSAIDs like ketorolac 30mg IV or oral analgesics such as acetaminophen 1000mg every 6 hours
- Adequate hydration, typically with IV fluids initially followed by oral intake of 2-3 liters daily The definitive treatment depends on stone size and location:
- Stones smaller than 5mm may pass spontaneously with medical expulsive therapy (tamsulosin 0.4mg daily)
- Larger stones or those causing obstruction may require urological intervention such as extracorporeal shock wave lithotripsy, ureteroscopy with stone extraction, or percutaneous nephrolithotomy Fever indicates infection and possible sepsis, so blood cultures should be obtained before starting antibiotics, and the patient should be monitored for signs of septic shock 1. Once the acute infection resolves, stone analysis and metabolic evaluation are recommended to prevent recurrence through dietary modifications and possibly preventive medications 1.
From the Research
Treatment for Kidney Stone and Fever
- The treatment for a patient with kidney stone and fever may involve antibiotic therapy, as recommended by current guidelines for infected obstructive stones 2.
- A study comparing two different protocols of antibiotic prophylaxis in percutaneous nephrolithotomy (PCNL) found that a single dose of ciprofloxacin infusion was more effective in preventing postoperative fever than cefotaxime 3.
- Another study emphasized the importance of urine tests and antibiotics usage in the management of obstructive ureteral stones in the emergency department 2.
- Factors that promote stone formation include low daily urine volumes, saturation of the urine with certain substances, acidic urine, and bacterial infection, and management aimed at preventing recurrences should address these factors 4.
- A study on pyelonephritis treatment found that cephalosporins had a lower failure rate compared to fluoroquinolones and trimethoprim-sulfamethoxazole, and that trimethoprim-sulfamethoxazole showed more bacterial resistance compared to the other agents 5.
Antibiotic Therapy
- The European Association of Urology (EAU) antibiotic guidelines endorse giving either a second or third-generation cephalosporin, trimethoprim-sulfamethoxazole, fluoroquinolone, or aminopenicillin with a β-lactamase inhibitor for urological procedures 3.
- A study found that a prophylactic regimen consisting of a single dose ciprofloxacin infusion during induction of surgery showed a higher efficacy as a preoperative antibacterial preparation, compared to cefotaxime, in protection against postoperative fever in patients undergoing PCNL 3.
- Antibiotics were given at the discretion of the provider without clear pattern in the management of obstructive ureteral stones in the emergency department 2.