What is a good antibiotic for acute Pyelonephritis (infection of the kidney)

From the Guidelines

For pyelonephritis, the most effective antibiotic treatment is ciprofloxacin (500–750 mg twice daily) or levofloxacin (750 mg once daily) for 5-7 days, as recommended by the European Association of Urology guidelines in 2024 1. When considering treatment options, it's crucial to prioritize the most recent and highest quality evidence to minimize morbidity, mortality, and improve quality of life. The choice of antibiotic should target the most common causative organism, Escherichia coli, while considering tissue penetration to reach the infected kidney. Key considerations include:

• Fluoroquinolone resistance should be <10% for empirical use of these agents 1.
• If fluoroquinolone resistance is a concern, an initial intravenous dose of a long-acting parenteral antimicrobial, such as ceftriaxone, should be administered 1.
• Treatment should be guided by local resistance patterns and adjusted based on urine culture results 1.
• Patients should complete the full course of antibiotics even if symptoms improve quickly, drink plenty of fluids, and use pain relievers like acetaminophen for fever and discomfort. Some other effective options for empirical oral antimicrobial therapy for uncomplicated pyelonephritis include:
• Trimethoprim sulfamethoxazole (160/800 mg twice daily) for 14 days 1.
• Cefpodoxime (200 mg twice daily) for 10 days 1.
• Ceftibuten (400 mg once daily) for 10 days 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).

Levofloxacin is a potential antibiotic for treating Acute Pyelonephritis.

• The drug label reports a clinical trial where levofloxacin 750 mg was administered orally once daily for 5 days to patients with complicated urinary tract infections and acute pyelonephritis.
• The study showed that levofloxacin had a bacteriologic cure rate in the Microbiologically Evaluable population at the test-of-cure (TOC) visit 2.
• However, it is essential to consult a healthcare professional to determine the best course of treatment for a specific patient.

From the Research

Antibiotic Options for Pyelonephritis

• The choice of antibiotic for pyelonephritis depends on various factors, including the severity of the infection, patient's medical history, and local resistance patterns 3, 4, 5.
• According to a 2014 study, empirical antibiotic therapy for acute uncomplicated pyelonephritis in non-pregnant adult women should be initiated promptly, and oral fluoroquinolones (ciprofloxacin or ofloxacin) or injectable third-generation cephalosporins (ceftriaxone) are recommended as first-line treatments 3.
• A 2019 study recommends antibiotics targeted toward Escherichia coli, Proteus, Klebsiella, and Staphylococcus saprophyticus for the treatment of pyelonephritis, with the duration of treatment varying from 7 to 14 days 4.
• A 2020 study suggests that knowledge of common uropathogens and local susceptibility patterns is essential in determining appropriate empiric antibiotic therapy for urinary tract infections, including pyelonephritis 5.
• A 2021 study found that short-course antibiotic treatment is at least as effective as longer courses for both microbiological and clinical success in the treatment of acute uncomplicated pyelonephritis 6.
• A 2022 study compared outcomes among outpatients treated for pyelonephritis with oral cephalosporins versus first-line agents and found no significant difference in urinary tract infection recurrence rates between the two groups 7.

Considerations for Antibiotic Resistance

• The development of antibiotic resistance is a growing concern, and the use of broader-spectrum antibiotics should be avoided as empirical therapy to preserve their efficacy in serious infections 3, 5.
• Local resistance patterns should be taken into account when selecting an antibiotic for pyelonephritis, and the use of fluoroquinolones and third-generation cephalosporins should be avoided in non-serious infections whenever possible 3, 5.
• The 2020 study highlights the importance of using new antimicrobials wisely to avoid resistance development and recommends treatment options for urinary tract infections caused by multidrug-resistant organisms 5.