From the Guidelines
Pyelonephritis treatment typically requires antibiotics to clear the kidney infection, with oral fluoroquinolones like ciprofloxacin (500mg twice daily for 7 days) or levofloxacin (750mg once daily for 5-7 days) being effective first-line options, as recommended by the most recent guidelines 1.
Treatment Options
- For uncomplicated cases, oral fluoroquinolones are preferred due to their efficacy and safety profile, with a treatment duration of 5-7 days 1.
- Alternatively, trimethoprim-sulfamethoxazole (160/800mg twice daily for 14 days) can be used if the pathogen is susceptible, although its use is limited by high resistance rates in some areas 1.
- For more severe cases requiring hospitalization, intravenous antibiotics such as ceftriaxone (1-2g daily), ampicillin plus gentamicin, or piperacillin-tazobactam are recommended until clinical improvement, followed by oral antibiotics to complete 7-14 days of treatment 1.
Important Considerations
- Patients should increase fluid intake to help flush bacteria from the urinary tract and take pain relievers like acetaminophen for fever and discomfort.
- It's crucial to complete the full antibiotic course even if symptoms improve quickly, as pyelonephritis can spread to the bloodstream and cause sepsis if left untreated.
- Follow-up urine cultures may be necessary to confirm the infection has cleared, especially in complicated cases or recurrent infections 1.
Choice of Antibiotics
- The choice of antibiotics should be based on local resistance patterns and susceptibility testing, with fluoroquinolones being a preferred option due to their broad-spectrum activity and high efficacy 1.
- In areas with high fluoroquinolone resistance, alternative antibiotics such as cephalosporins or carbapenems may be necessary, although their use should be guided by susceptibility testing and local resistance patterns 1.
From the FDA Drug Label
- 11 Acute Pyelonephritis: 5 or 10 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia [see Clinical Studies (14.7,14.8)].
The treatment for Pyelonephritis (infection of the kidney) is levofloxacin, which is indicated for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia. The recommended treatment regimen is a 5 or 10 day course of levofloxacin tablets 2.
- Key points:
- Levofloxacin is the indicated treatment
- Escherichia coli is the targeted pathogen
- 5 or 10 day treatment regimen is recommended
- Concurrent bacteremia is included in the indication 2
From the Research
Treatment Options for Pyelonephritis
- The treatment for pyelonephritis typically involves antibiotic therapy, with the choice of antibiotic depending on the severity of the infection and the patient's overall health 3, 4, 5, 6, 7.
- For mild uncomplicated pyelonephritis, outpatient oral antibiotic therapy with a fluoroquinolone, such as ciprofloxacin or levofloxacin, is often effective 3, 5, 7.
- Other effective alternatives for outpatient treatment include extended-spectrum penicillins, amoxicillin-clavulanate potassium, cephalosporins, and trimethoprim-sulfamethoxazole 5, 6.
- For more severe infections or those that do not respond to outpatient treatment, inpatient intravenous antibiotic therapy may be necessary, with options including fluoroquinolones, aminoglycosides, and third-generation cephalosporins 4, 5, 6.
Duration of Treatment
- The standard duration of antibiotic therapy for pyelonephritis is 7-14 days 3, 5, 6.
- A study found that a 7-day course of ciprofloxacin was non-inferior to a 14-day course in women with acute pyelonephritis 3.
Considerations for Antibiotic Resistance
- The increasing resistance of uropathogens to commonly used antibiotics is a concern, and antibiotic therapy should be guided by antimicrobial susceptibility testing whenever possible 4, 6, 7.
- The choice of empirical antibiotic therapy should take into account the local resistance patterns and the patient's individual risk factors for resistance 6, 7.