Which cephalosporins (a class of beta-lactam antibiotics) can be used to treat kidney infections (pyelonephritis)?

Cephalosporins for Kidney Infection (Pyelonephritis)

For kidney infections (pyelonephritis), the recommended cephalosporins include ceftriaxone, cefotaxime, cefepime, ceftazidime, and oral options such as cefpodoxime and ceftibuten. These medications are effective against the common causative pathogens and achieve adequate concentrations in the urinary tract.

Parenteral (IV/IM) Cephalosporins for Pyelonephritis

First-line parenteral options:

• Ceftriaxone: 1-2g once daily - most commonly recommended due to its convenient once-daily dosing and excellent efficacy 1, 2
• Cefotaxime: 2g three times daily - effective but requires more frequent dosing 1, 3
• Cefepime: 1-2g twice daily - broader spectrum option for more resistant pathogens 1

Additional parenteral options for complicated or resistant infections:

• Ceftazidime: 2g three times daily - particularly useful for Pseudomonas infections 1
• Ceftolozane-tazobactam: 1.5g three times daily - for multidrug-resistant pathogens 1
• Ceftazidime-avibactam: 2.5g three times daily - for extended-spectrum beta-lactamase (ESBL) producing organisms 1

Oral Cephalosporins for Pyelonephritis

For less severe cases or step-down therapy after initial IV treatment:

• Cefpodoxime: 200mg twice daily for 10 days 1
• Ceftibuten: 400mg once daily for 10 days 1

Clinical Considerations

Patient Selection:

• Parenteral cephalosporins are preferred for hospitalized patients with pyelonephritis 1
• Oral cephalosporins can be used for less severe cases or as step-down therapy after initial IV treatment 1
• Consider local resistance patterns when selecting specific agents 1, 4

Special Populations:

• For pregnant women with pyelonephritis, ceftriaxone or cefotaxime are safe options 1
• In children, ceftriaxone has shown superior efficacy compared to cefotaxime for upper UTIs 3

Antimicrobial Stewardship:

• Reserve newer broad-spectrum cephalosporins (ceftazidime-avibactam, ceftolozane-tazobactam) for documented resistant infections 1
• Carbapenems and novel broad-spectrum agents should only be considered when culture results indicate multidrug-resistant organisms 1

Practical Recommendations

• For outpatient treatment: Consider ceftriaxone IM once daily or oral cefpodoxime/ceftibuten 1, 2
• For hospitalized patients: Start with IV ceftriaxone, cefotaxime, or cefepime 1
• For suspected resistant pathogens: Consider ceftazidime, ceftazidime-avibactam, or ceftolozane-tazobactam based on local resistance patterns 1

Caveats and Pitfalls

• Cefoperazone and ceftriaxone have significant biliary excretion and may achieve lower urinary concentrations in patients with renal dysfunction 5
• E. coli resistance to third-generation cephalosporins is increasing (from 1% in 2005 to 10% in 2012 in some regions) 4
• Always adjust therapy based on culture and sensitivity results when available 1
• Monitor for adverse effects including hypersensitivity reactions and C. difficile infection 4
• First-generation cephalosporins are not typically recommended for pyelonephritis due to inadequate tissue penetration and increasing resistance 5, 4