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
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