What is the treatment for pyelonephritis (kidney infection)?

From the Guidelines

Treatment for kidney infection should prioritize oral antibiotics like ciprofloxacin (500–750 mg twice daily) for 7 days, with or without an initial 400-mg dose of intravenous ciprofloxacin, in patients not requiring hospitalization where the prevalence of resistance of community uropathogens to fluoroquinolones is not known to exceed 10%. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of tailoring empirical therapy based on local resistance patterns and the infecting uropathogen 1.

Key Considerations

• For mild to moderate infections, oral antibiotics are the preferred choice, with options including ciprofloxacin, levofloxacin, trimethoprim-sulfamethoxazole, cefpodoxime, and ceftibuten, as outlined in the European Association of Urology guidelines 1.
• Severe infections may require hospitalization and intravenous antibiotics such as ceftriaxone or gentamicin, with the choice of agent based on local resistance data and susceptibility results 1.
• It is crucial to take the full course of antibiotics even if symptoms improve, and pain relievers like acetaminophen or ibuprofen can help manage discomfort.
• Drinking plenty of water (2-3 liters daily) helps flush bacteria from the urinary system, and patients should seek immediate medical attention if they experience high fever, severe pain, vomiting, or inability to keep down fluids.

Management Approach

• Urine culture and antimicrobial susceptibility testing should be performed in all cases of pyelonephritis to guide therapy 1.
• Evaluation of the upper urinary tract via ultrasound should be performed to rule out urinary tract obstruction or renal stone disease in patients with a history of urolithiasis, renal function disturbances, or a high urine pH 1.
• Additional investigations, such as a contrast-enhanced computed tomography scan, or excretory urography, should be considered if the patient remains febrile after 72 h of treatment, or immediately if there is a deterioration in clinical status 1.

From the FDA Drug Label

1. 9 Complicated Urinary Tract Infections: 5 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis [see Clinical Studies (14.7)].
2. 10 Complicated Urinary Tract Infections: 10 Day Treatment Regimen Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa [see Clinical Studies (14.8)].
3. 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)].

Treatment for kidney infection:

• Levofloxacin is indicated for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia.
• The treatment regimen for acute pyelonephritis is 5 or 10 days.
• Levofloxacin is also indicated for the treatment of complicated urinary tract infections due to various bacteria, including Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis.
• The treatment regimen for complicated urinary tract infections is 5 or 10 days, depending on the severity of the infection. 2

From the Research

Treatment Options for Kidney Infection

• The treatment of kidney infection, also known as pyelonephritis, typically involves the use of antimicrobial agents 3.
• The choice of antimicrobial agent may depend on the severity of the infection, the presence of underlying medical conditions, and the susceptibility of the causative organism to different antibiotics 4, 5.
• Cephalosporins, such as cefazolin, cephalexin, and ceftriaxone, have been shown to be effective in treating uncomplicated pyelonephritis 6.
• Fluoroquinolones, such as ciprofloxacin, and trimethoprim-sulfamethoxazole are also commonly used to treat pyelonephritis, but the increasing prevalence of antimicrobial resistance may limit their effectiveness in some cases 3, 5.

Duration of Antibiotic Treatment

• The optimal duration of antibiotic treatment for kidney infection is not well established, but shorter courses of antibiotics may be as effective as longer courses in reducing the risk of infection-related complications 7.
• A study found that longer courses of antibiotics were not more effective than shorter courses in reducing the risk of infection-related hospitalizations, and that shorter courses may be associated with a lower risk of developing complications 7.
• However, the duration of treatment may depend on the severity of the infection, the presence of underlying medical conditions, and the response to treatment 3, 4.

Considerations for Treatment

• The treatment of kidney infection should be guided by the results of urine culture and susceptibility testing, when available 3, 4.
• The presence of underlying medical conditions, such as diabetes or immunosuppression, may require modification of the treatment regimen 3, 6.
• The increasing prevalence of antimicrobial resistance highlights the need for judicious use of antibiotics and the development of effective antimicrobial-sparing preventive approaches 3, 5.