From the Guidelines
For the treatment of pyelonephritis requiring intravenous therapy, ciprofloxacin is the preferred option in areas with low fluoroquinolone resistance rates, while ertapenem is generally preferred in areas with high fluoroquinolone resistance rates or for patients with risk factors for resistant organisms. The choice between ertapenem and ciprofloxacin depends on several factors, including local resistance patterns, patient allergies, and comorbidities. According to the guidelines by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases 1, ciprofloxacin (400mg IV every 12 hours) is an appropriate choice for uncomplicated cases in regions with low resistance rates. Ertapenem (1g IV once daily) offers broader coverage against extended-spectrum beta-lactamase (ESBL) producing organisms but should be reserved for appropriate cases to prevent antimicrobial resistance.
- Key considerations for selecting between these antibiotics include:
- Local resistance patterns: Ciprofloxacin is preferred in areas with low fluoroquinolone resistance rates, while ertapenem is preferred in areas with high resistance rates 1.
- Patient allergies and comorbidities: The choice of antibiotic should take into account the patient's medical history and potential allergies 1.
- Treatment duration: Typically ranges from 7-14 days, with consideration for switching to oral therapy after clinical improvement (usually within 48-72 hours) 1.
- Regardless of the antibiotic chosen, patients should be monitored for clinical improvement within 48-72 hours, and therapy should be adjusted based on urine culture results when available 1.
From the FDA Drug Label
- 4 Complicated Urinary Tract Infections Including Pyelonephritis Ertapenem for injection is indicated for the treatment of adult patients and pediatric patients (3 months of age and older) with complicated urinary tract infections including pyelonephritis due to Escherichia coli, including cases with concurrent bacteremia, or Klebsiella pneumoniae.
Ertapenem is recommended for the treatment of pyelonephritis, as it is indicated for complicated urinary tract infections, including pyelonephritis, due to susceptible bacteria such as Escherichia coli or Klebsiella pneumoniae 2.
- Key points:
- Ertapenem is indicated for pyelonephritis.
- The recommended dose for adults and pediatric patients 13 years of age and older is 1 gram given once a day.
- Ertapenem has been studied for the treatment of complicated urinary tract infections, including pyelonephritis. There is no information in the provided drug label that supports the use of ciprofloxacin for pyelonephritis, as the label is for ertapenem.
From the Research
IV Antibiotic Options for Pyelonephritis
- Ertapenem and ciprofloxacin are two potential IV antibiotic options for the treatment of pyelonephritis.
- A study from 2004 3 compared the efficacy and safety of ertapenem and ceftriaxone for the treatment of complicated urinary tract infections, including pyelonephritis, and found that both treatments were equivalent in terms of microbiological response.
Considerations for Antibiotic Choice
- The choice of antibiotic should be guided by local resistance patterns and the results of urine culture and antimicrobial susceptibility testing 4, 5.
- Fluoroquinolones, such as ciprofloxacin, and trimethoprim/sulfamethoxazole are effective oral antibiotics for most cases of pyelonephritis, but increasing resistance makes empiric use problematic 4.
- For patients with suspected or confirmed extended-spectrum beta-lactamase (ESBL)-producing organisms, parenteral treatment options include carbapenems, such as ertapenem, and other broad-spectrum antibiotics 6, 7.
Ertapenem vs. Ciprofloxacin
- Ertapenem is a carbapenem antibiotic with broad-spectrum activity against Gram-negative bacteria, including ESBL-producing organisms 3, 6.
- Ciprofloxacin is a fluoroquinolone antibiotic with activity against a range of Gram-negative bacteria, but its use may be limited by resistance patterns 4, 6.
- A study from 2020 7 found that piperacillin-tazobactam, another broad-spectrum antibiotic, may be a reasonable alternative to carbapenems for the management of ESBL-producing pyelonephritis, but the efficacy of ertapenem and ciprofloxacin in this setting is not directly compared.