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

From the Guidelines

Pyelonephritis treatment should typically start with oral antibiotics like ciprofloxacin (500mg twice daily for 7 days) or levofloxacin (750 mg once daily for 5 days), provided the local fluoroquinolone resistance is less than 10%. The choice of antibiotic regimen depends on the severity of the infection and local resistance patterns 1. For uncomplicated cases, the following oral antibiotics are suggested:

• Ciprofloxacin: 500–750 mg twice daily for 7 days
• Levofloxacin: 750 mg once daily for 5 days
• Trimethoprim sulfamethoxazole: 160/800 mg twice daily for 14 days
• Cefpodoxime: 200 mg twice daily for 10 days
• Ceftibuten: 400 mg once daily for 10 days

If the fluoroquinolone resistance is 10% or higher, an initial intravenous dose of a long-acting parenteral antimicrobial, such as ceftriaxone, should be administered 1. Severe cases requiring hospitalization may need intravenous antibiotics like ceftriaxone (1-2g daily), ampicillin plus gentamicin, or piperacillin-tazobactam until improvement, followed by oral antibiotics to complete 10-14 days of treatment. Supportive care, including adequate hydration, fever control, and pain management, is also essential. Patients should increase fluid intake, rest, and complete the entire antibiotic course even if symptoms improve. Follow-up urine cultures are recommended to ensure infection clearance. The choice of antibiotic should consider local resistance patterns and patient-specific factors like allergies and pregnancy status 1.

From the FDA Drug Label

1. 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 tablets, which are indicated for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia. The recommended treatment regimen is 5 or 10 days 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.
• For mild uncomplicated pyelonephritis, outpatient oral antibiotic therapy with a fluoroquinolone, such as ciprofloxacin or levofloxacin, is often effective 3, 5.
• Other effective alternatives for outpatient treatment include extended-spectrum penicillins, amoxicillin-clavulanate potassium, cephalosporins, and trimethoprim-sulfamethoxazole 3.
• For more severe cases or complicated infections, inpatient treatment with intravenous antibiotics, such as a fluoroquinolone, aminoglycoside with or without ampicillin, or a third-generation cephalosporin, may be necessary 3, 4, 6.

Duration of Therapy and Follow-up

• The standard duration of antibiotic therapy for pyelonephritis is typically 7 to 14 days 3.
• Urine culture should be repeated one to two weeks after completion of antibiotic therapy to ensure that the infection has been fully cleared 3.
• If the patient does not respond to treatment, repeat blood and urine cultures, as well as imaging studies, may be necessary to determine the cause of treatment failure 3, 4.

Special Considerations

• Pregnant patients with pyelonephritis are at increased risk of severe complications and should be admitted and treated initially with parenteral therapy 4.
• Patients with underlying anatomic or functional abnormalities, or those who are immunocompromised, may require more aggressive treatment and closer monitoring 3, 6.
• The increasing prevalence of antibiotic-resistant organisms, such as extended-spectrum beta-lactamase-producing E. coli, highlights the need for careful selection of antibiotic therapy and consideration of local resistance patterns 7, 5.