Young, otherwise healthy patients with pyelonephritis may be treated as outpatients. Use the same medications as listed in Cystitis, except exclude TMP/SMX from treatment regimen (due to resistance). Consider initiating therapy with a single dose of parenteral medication as listed below for complicated pyelonephritis. Course: 14 days.


Admission is recommended for patients with pyelonephritis complicated by elderly, pregnant, renal insufficiency, or structural abnormality (including a single kidney), immunocompromised (e.g., diabetics, HIV, transplant, chemotherapy), intractable nausea/vomiting, sickle cell anemia, renal calculi, toxic appearance, unremitting fever.

2. Cefotaxime (Claforan) 1 g IV q12h [B]

3. Ciprofloxacin 400 mg IV q12h [C]

4. Levofloxacin (Levaquin) 500 mg IV qd [C]

5. Ampicillin 2 g IV q4h [B] PLUS gentamicin (Garamycin) 2 mg/kg IV loading dose, then 1.7 mg/kg IV q8h OR 5.1 mg/kg IV QD (monitor serum levels) [D]

6. Ampicillin/sulbactam (Unasyn) 3.0 g IV q6h [B]

7. Ticarcillin/clavulanic acid (Timentin) 3.1 g IV q6h [B]

8. Piperacillin/tazobactam (Zosyn) 3.375 g IV q6h [B]

9. Imipenem (Primaxin) 500-1000 mg IV q6h [C]

Organisms: E. coli, Enterococcus, Enterobacteriaceae Sterile Pyuria

(Pyuria without bacteria or with negative culture. Consider evaluation for tuberculosis as possible etiology.)

1. Doxycycline 100 mg PO bid [D]

2. Tetracycline 500 mg PO qid [D]

3. Erythromycin 500 mg PO qid [B, except estolate contraindicated]

5. Levofloxacin (Levaquin) 250 mg PO qd [C]

6. Azithromycin (Zithromax) 500 mg PO initial dose, then 250 mg PO qd for 4 days [B]

Course: 7 days (except azithromycin as noted)

Organisms: C. trachomatis, Ureaplasma urealyticum, tuberculosis

Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

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