What are the effective antibiotics for pyelonephritis (infection of the kidney)?

From the Guidelines

For pyelonephritis, fluoroquinolones like ciprofloxacin (500mg twice daily for 7 days) or levofloxacin (750mg once daily for 5 days) are the recommended first-line antibiotics for outpatient treatment, as suggested by the European Association of Urology guidelines 1.

Key Considerations

• The choice of antibiotic should be guided by local resistance patterns and adjusted based on urine culture results.
• Fluoroquinolone resistance should be <10% for empirical use, and an initial intravenous dose of a long-acting parenteral antimicrobial like ceftriaxone should be administered if such agents are used empirically 1.
• Other options like trimethoprim-sulfamethoxazole (160/800mg twice daily for 14 days) can be considered if the bacteria is susceptible.

Treatment Duration and Adjustments

• The treatment duration for fluoroquinolones can be 5-7 days, while trimethoprim-sulfamethoxazole is typically given for 14 days.
• Patients should complete the full course of antibiotics even if symptoms improve quickly.
• Adjustments to the treatment regimen should be made based on urine culture results and local resistance patterns.

Additional Recommendations

• Patients should drink plenty of fluids and take pain relievers like acetaminophen for fever and discomfort.
• Severe cases, pregnancy, or immunocompromised patients may require longer treatment courses or hospitalization.
• Intravenous options like ceftriaxone (1-2g daily), gentamicin (5-7mg/kg daily), or piperacillin-tazobactam (3.375g every 6 hours) can be considered for hospitalized patients.

From the FDA Drug Label

The microbiologic eradication rate by patient infection at 5 to 18 days after completion of therapy was 75% in the levofloxacin group and 76.8% in the ciprofloxacin group The bacteriologic cure rates overall for levofloxacin and control at the test-of-cure (TOC) visit for the group of all patients with a documented pathogen at baseline Clinical success (cure + improvement with no need for further antibiotic therapy) rates in microbiologically evaluable population 5 to 18 days after completion of therapy were 75% for levofloxacin-treated patients and 72.8% for ciprofloxacin-treated patients

14. 7 Complicated Urinary Tract Infections and Acute Pyelonephritis: 5 Day Treatment Regimen
15. 8 Complicated Urinary Tract Infections and Acute Pyelonephritis: 10 Day Treatment Regimen CLINICAL STUDIES Complicated Urinary Tract Infection and Pyelonephritis – Efficacy in Pediatric Patients: Clinical Success and Bacteriologic Eradication at Test of Cure (5 to 9 Days Post-Therapy)

Good antibiotics for pyelonephritis include:

• Levofloxacin: with a microbiologic eradication rate of 75% and clinical success rate of 75% 2
• Ciprofloxacin: with a microbiologic eradication rate of 76.8% and clinical success rate of 72.8% 2, and 84.4% bacteriologic eradication by patient at 5 to 9 days post-treatment 3

From the Research

Antibiotics for Pyelonephritis

• Ciprofloxacin is effective for the treatment of acute uncomplicated pyelonephritis, with a 7-day regimen showing greater bacteriologic and clinical cure rates than a 14-day trimethoprim-sulfamethoxazole regimen 4.
• A pharmacokinetic-pharmacodynamic assessment suggests that ciprofloxacin, amoxicillin, amoxicillin-clavulanic acid, cephalexin, and fosfomycin trometamol may be effective for the oral treatment of pyelonephritis, with ciprofloxacin being effective at lower doses than currently prescribed 5.
• A systematic review of randomized clinical trials found that oral antibiotics such as cefaclor, ciprofloxacin, and norfloxacin have comparable clinical success rates for the outpatient treatment of pyelonephritis, ranging from 83 to 95% 6.
• Levofloxacin has been shown to be effective for the treatment of complicated urinary tract infections and acute pyelonephritis, with a short-course intravenous regimen being non-inferior to a conventional intravenous/oral regimen 7.
• Cephalosporins, including cefazolin, cephalexin, cefuroxime, cefotaxime, cefdinir, cefditoren, and ceftriaxone, may be viable treatment options for the management of uncomplicated pyelonephritis, with no trials reporting inferiority of clinical treatment outcomes compared to fluoroquinolones or sulfamethoxazole-trimethoprim 8.

Key Findings

• Ciprofloxacin is a commonly recommended antibiotic for pyelonephritis, with a 7-day regimen being effective for acute uncomplicated cases 4, 5.
• Other antibiotics such as amoxicillin, amoxicillin-clavulanic acid, cephalexin, and fosfomycin trometamol may also be effective for oral treatment 5.
• Levofloxacin and cephalosporins are additional options for the treatment of pyelonephritis, with varying degrees of effectiveness and potential for use in uncomplicated cases 7, 8.