What is the treatment for pyelonephritis using ciprofloxacin (Cipro, fluoroquinolone antibiotic)?

From the Guidelines

Ciprofloxacin is an effective treatment option for pyelonephritis, typically prescribed at 500 mg orally twice daily for 7 days in uncomplicated cases, as recommended by the European Association of Urology guidelines 1.

Key Considerations

• The treatment duration and dosage may vary depending on the severity of the infection and the patient's response to therapy.
• Before starting treatment, a urine culture should be obtained to confirm the causative organism and its susceptibility, as recommended by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases 1.
• Patients should be advised to drink plenty of fluids, complete the entire course of antibiotics even if symptoms improve, and report worsening symptoms or lack of improvement within 48-72 hours.
• Ciprofloxacin works by inhibiting bacterial DNA gyrase and topoisomerase IV, preventing DNA replication and ultimately killing the bacteria, and is particularly effective against gram-negative organisms like E. coli, which causes approximately 80% of pyelonephritis cases.
• However, increasing resistance rates to fluoroquinolones in some regions may necessitate alternative antibiotics based on local resistance patterns and culture results, as noted in the American College of Physicians' guidelines 1.

Treatment Recommendations

• For uncomplicated pyelonephritis, oral ciprofloxacin (500-750 mg twice daily) for 7 days is a recommended treatment option, as outlined in the European Association of Urology guidelines 1.
• For complicated pyelonephritis, treatment may be extended to 10-14 days, and alternative antibiotics may be considered based on culture results and local resistance patterns.
• An initial intravenous dose of a long-acting parenteral antimicrobial, such as ceftriaxone, may be administered in severe cases or when oral therapy is not possible, as recommended by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases 1.

From the FDA Drug Label

Complicated Urinary Tract Infection and Pyelonephritis – Efficacy in Pediatric Patients: Ciprofloxacin, administered I. V. and/or orally, was compared to a cephalosporin for treatment of complicated urinary tract infections (cUTI) and pyelonephritis in pediatric patients 1 to 17 years of age The clinical success and bacteriologic eradication rates in the Per Protocol population were similar between ciprofloxacin and the comparator group Clinical Response at 5 to 9 Days Post-Treatment 95.7% (202/211) Bacteriologic Eradication by Patient at 5 to 9 Days Post-Treatment* 84.4% (178/211)

Treatment for pyelonephritis with ciprofloxacin:

• Ciprofloxacin is effective in treating pyelonephritis in pediatric patients, with a clinical success rate of 95.7% and bacteriologic eradication rate of 84.4% at 5 to 9 days post-treatment.
• However, ciprofloxacin is not a drug of first choice in the pediatric population due to an increased incidence of adverse events compared to controls, including events related to joints and/or surrounding tissues 2.
• The rates of these events in pediatric patients with complicated urinary tract infection and pyelonephritis within six weeks of follow-up were 9.3% (31/335) versus 6% (21/349) for control agents 2.

From the Research

Treatment for Pyelonephritis with Ciprofloxacin

• Ciprofloxacin is a commonly used antibiotic for the treatment of pyelonephritis, with studies showing its efficacy in both short-term and long-term outcomes 3, 4.
• A study published in the Lancet found that ciprofloxacin for 7 days was non-inferior to 14 days in women with acute pyelonephritis, with short-term clinical cure rates of 97% and 96%, respectively 3.
• Another study published in the Journal of Urology found that extended-release ciprofloxacin (1,000 mg once daily) was as effective as conventional ciprofloxacin (500 mg twice daily) for 7 to 14 days in adults with complicated urinary tract infections or acute uncomplicated pyelonephritis 4.
• However, the use of ciprofloxacin should take into account the increasing resistance rates, particularly in patients who have been treated with quinolones in the past or have been recently hospitalized 5.
• Alternative treatments, such as cephalosporins, have also been shown to be effective in the treatment of pyelonephritis, with some studies suggesting similar or better outcomes compared to fluoroquinolones and trimethoprim-sulfamethoxazole 6, 7.

Efficacy and Safety of Ciprofloxacin

• Ciprofloxacin has been shown to be effective in resolving symptoms of pyelonephritis within 5 to 7 days in about 96% of women 5.
• The drug is generally well-tolerated, with common adverse events including myalgia, itching, and mucosal candida infection 3, 4.
• However, ciprofloxacin can also cause more serious adverse events, such as neuropsychiatric disorders, photosensitivity, tendon disorders, arrhythmia, and cardiac conduction disorders, as well as Clostridium difficile infection 5.

Comparison with Other Treatments

• Ciprofloxacin has been compared to other antibiotics, such as cephalosporins, trimethoprim-sulfamethoxazole, and fluoroquinolones, in the treatment of pyelonephritis 6, 7.
• Some studies have found that cephalosporins may be associated with lower rates of treatment failure and resistance compared to fluoroquinolones and trimethoprim-sulfamethoxazole 6, 7.
• However, the choice of antibiotic should be based on individual patient factors, such as allergy history, renal function, and local resistance patterns, as well as the severity of the infection 5.