Should faropenem (generic name) be continued for a patient with pyelonephritis and urosepsis who has recovered from shock and is planned for discharge?

Management of Faropenem in Recovered Pyelonephritis Urosepsis

Faropenem should be discontinued and switched to a recommended oral antibiotic regimen for the completion of treatment in a patient with pyelonephritis and urosepsis who has recovered from shock and is planned for discharge.

Antibiotic Selection for Pyelonephritis

• For patients with pyelonephritis who have recovered from urosepsis and are ready for discharge, oral fluoroquinolones or cephalosporins are the recommended agents for continued treatment 1
• Faropenem is not listed among the recommended antimicrobial agents for pyelonephritis in current guidelines 1
• The European Association of Urology specifically recommends fluoroquinolones and cephalosporins as the only antimicrobial agents for oral empiric treatment of uncomplicated pyelonephritis 1

Duration of Therapy

• A 7-10 day course of antibiotics is generally adequate for most serious infections associated with sepsis and septic shock 1
• Shorter courses (5-7 days) are appropriate for patients with rapid clinical resolution following effective source control of urinary sepsis and those with anatomically uncomplicated pyelonephritis 1
• Daily assessment for de-escalation of antimicrobial therapy is recommended in patients with sepsis and septic shock 1

Recommended Discharge Regimens

• For oral therapy after recovery from pyelonephritis with urosepsis, the following options are recommended:
  • Ciprofloxacin (if local resistance rates are <10%) 1, 2
  • Levofloxacin (if local resistance rates are <10%) 1, 2
  • Oral cephalosporins (with consideration that they achieve lower blood and urinary concentrations than intravenous formulations) 1

Important Considerations

• Antimicrobial therapy should be narrowed once pathogen identification and sensitivities are established 3
• The choice between recommended agents should be based on local resistance patterns and optimized according to culture results 1, 4
• Agents such as nitrofurantoin, oral fosfomycin, and pivmecillinam should be avoided as there are insufficient data regarding their efficacy in pyelonephritis 1

Common Pitfalls to Avoid

• Using antibiotics not recommended in guidelines for pyelonephritis treatment 1, 2
• Continuing broad-spectrum antibiotics unnecessarily after clinical improvement and when narrower-spectrum options are available 1, 3
• Failing to adjust antimicrobial therapy according to pathogen susceptibility once culture results are available 4, 3
• Using fluoroquinolones empirically in areas with high resistance rates (>10%) 4, 2

Follow-up Recommendations

• If the patient remains febrile after 72 hours of appropriate treatment, or if there is deterioration in clinical status, additional investigations such as contrast-enhanced computed tomography should be considered 1
• Ensure that any urinary tract obstruction or anatomical abnormality has been addressed before discharge 4