From the Guidelines
The recommended antibiotics for the treatment of Pyelonephritis are fluoroquinolones and cephalosporins.
Treatment Options
- For oral empiric treatment of uncomplicated pyelonephritis, fluoroquinolones (such as ciprofloxacin or levofloxacin) and cephalosporins are recommended 1.
- For patients with uncomplicated pyelonephritis requiring hospitalization, initial treatment with an intravenous antimicrobial regimen such as a fluoroquinolone, an aminoglycoside (with or without ampicillin), or an extended-spectrum cephalosporin or penicillin is recommended 1.
Specific Regimens
- Suggested regimens for empirical oral antimicrobial therapy for uncomplicated pyelonephritis include:
- Ciprofloxacin: 500-750 mg twice daily for 7 days
- Levofloxacin: 750 mg once daily for 5 days
- Cefpodoxime: 200 mg twice daily for 10 days
- Ceftibuten: 400 mg once daily for 10 days 1
- Suggested regimens for empirical parenteral antimicrobial therapy for uncomplicated pyelonephritis include:
- Ciprofloxacin: 400 mg twice daily
- Levofloxacin: 750 mg once daily
- Ceftriaxone: 1-2 g once daily
- Cefepime: 1-2 g twice daily 1
Considerations
- The choice of antibiotic should be based on local resistance patterns and optimized 1.
- Fluoroquinolone resistance should be less than 10% for empirical use 1.
- Alternative dosing strategies, such as 5-day or 7-day courses, may be effective, but further study is needed 1.
From the Research
Recommended Antibiotics for Pyelonephritis
The following antibiotics are recommended for the treatment of pyelonephritis:
- Aminoglycosides 2, 3
- Amino- or carboxypenicillins (alone or associated with clavulanic acid) 2
- Ureidopenicillins (e.g. mezlocillin, piperacillin) 2
- Fluoroquinolones (e.g. ciprofloxacin, ofloxacin, pefloxacin) 2, 3, 4, 5, 6
- Cephalosporins 2, 4, 5, 6
- Monobactams (e.g. aztreonam) 2
- Carbapenems (e.g. imipenem) 2
- The combination of trimethoprim plus a sulphonamide [e.g. cotrimoxazole (trimethoprim/sulfamethoxazole)] 2, 3, 4
Specific Recommendations
- For outpatient oral antibiotic therapy, fluoroquinolones, extended-spectrum penicillins, amoxicillin-clavulanate potassium, cephalosporins, and trimethoprim-sulfamethoxazole are effective alternatives 4
- For inpatient treatment, intravenous treatment is recommended with a fluoroquinolone, aminoglycoside with or without ampicillin, or a third-generation cephalosporin 4
- For acute uncomplicated pyelonephritis in women, oral fluoroquinolones (ciprofloxacin or ofloxacin) or injectable third-generation cephalosporin ceftriaxone are recommended as first-choice empirical antibiotic treatment 5
- Alternative treatments/novel dosing regimens for oral antibiotics, such as amoxicillin, amoxicillin-clavulanic acid, cephalexin, and fosfomycin trometamol, may be considered based on pharmacokinetic-pharmacodynamic assessments 6