What is the treatment for Pyelonephritis (infection of the kidney)?

From the Guidelines

Pyelonephritis treatment typically involves antibiotics, with the specific regimen depending on severity and patient factors, and according to the most recent guidelines from the European Association of Urology in 2024 1, fluoroquinolones and cephalosporins are the only antimicrobial agents that can be recommended for oral empiric treatment of uncomplicated pyelonephritis. For uncomplicated cases, oral fluoroquinolones like ciprofloxacin (500mg twice daily for 7 days) or levofloxacin (750mg once daily for 5-7 days) are effective first-line options, as suggested in the 2024 guidelines 1. Some key points to consider in the treatment of pyelonephritis include:

• The choice of antibiotic should be based on local resistance patterns and the severity of the infection, as recommended by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases in 2011 1.
• For more severe cases requiring hospitalization, intravenous options include ceftriaxone (1-2g daily), ampicillin plus gentamicin, or piperacillin-tazobactam until clinical improvement, followed by oral therapy to complete 7-14 days total, as outlined in the 2024 guidelines 1.
• Patients should increase fluid intake to promote urinary flow and can take acetaminophen or NSAIDs for fever and pain relief.
• Follow-up urine cultures are recommended 1-2 weeks after completing antibiotics to ensure resolution, as suggested by the European Association of Urology in 2024 1.
• Antibiotics work by targeting bacterial cell walls or protein synthesis, eliminating the infection while the body's immune system assists in clearance.
• Prompt treatment is essential to prevent complications like sepsis or renal scarring, as emphasized in the 2011 guidelines 1.

From the FDA Drug Label

14.7 Complicated Urinary Tract Infections and Acute Pyelonephritis: 5 Day Treatment Regimen To evaluate the safety and efficacy of the higher dose and shorter course of levofloxacin, 1109 patients with cUTI and AP were enrolled in a randomized, double-blind, multicenter clinical trial conducted in the U.S. from November 2004 to April 2006 comparing levofloxacin 750 mg I.V. or orally once daily for 5 days (546 patients) with ciprofloxacin 400 mg I.V. or 500 mg orally twice daily for 10 days (563 patients).

The treatment for Acute Pyelonephritis (AP) is levofloxacin 750 mg orally once daily for 5 days or ciprofloxacin 400 mg I.V. or 500 mg orally twice daily for 10 days 2. Key points:

• The treatment is for complicated urinary tract infections and acute pyelonephritis.
• The 5-day treatment regimen with levofloxacin 750 mg once daily is a possible treatment option.
• The 10-day treatment regimen with ciprofloxacin 400 mg I.V. or 500 mg orally twice daily is another possible treatment option.

From the Research

Treatment Options for Pyelonephritis

The treatment for pyelonephritis, a bacterial infection of the kidney, typically involves antibiotics. The choice of antibiotic depends on various factors, including the severity of the infection, the patient's overall health, and the susceptibility of the bacteria to different antibiotics.

Antibiotic Regimens

Some common antibiotic regimens for pyelonephritis include:

• Extended-spectrum cephalosporins, such as ceftriaxone 3, 4, 5
• Fluoroquinolones, such as levofloxacin and ciprofloxacin 3, 4, 5, 6, 7
• Aminoglycosides, such as gentamicin 4, 5

Considerations for Antibiotic Choice

When choosing an antibiotic, it's essential to consider the following factors:

• Resistance rates: The prevalence of antibiotic-resistant bacteria in the community or hospital setting 3, 4, 5
• Patient factors: Such as pregnancy, allergies, or underlying medical conditions 4, 5
• Severity of the infection: Patients with severe illness or complications may require hospitalization and intravenous antibiotics 4

Duration of Treatment

The duration of treatment for pyelonephritis typically ranges from 7 to 14 days, depending on the severity of the infection and the patient's response to treatment 3, 6, 7.

Adjusting Treatment Based on Susceptibility Testing

It's crucial to adjust the antibiotic regimen based on the results of antimicrobial susceptibility testing to ensure effective treatment and minimize the risk of antibiotic resistance 3, 4, 5, 7.