How is uncomplicated pyelonephritis treated?
Acute nonobstructive pyelonephritis is a serious infection requiring prompt investigation and treatment. If the patient is clinically stable and can tolerate oral therapy, ciprofloxacin 500 mg twice a day for 7 days or levofloxacin 750 mg once a day for 5 days is a recommended empiric regimen. An initial single parenteral dose of ceftriaxone or an aminoglycoside may be considered. Two regular-strength tablets of TMP/SMX twice a day for 14 days is also effective for susceptible organisms, but is not recommended for empiric therapy because of the high prevalence of TMP/SMX resistance in many regions. Effective parenteral antimicrobial regimens include ceftriaxone 1 to 2 g daily or gentamicin or tobramycin 3 to 5 mg/kg daily. Where resistant strains are likely, alternate regimens, such as a carbapenem, should be initiated. The clinical status and urine culture results should be reviewed at 48 to 72 hours following the initiation of antimicrobial therapy. Patients receiving parenteral therapy who have an adequate clinical response are then switched to appropriate oral therapy to complete a therapeutic course. If the infecting organism is resistant to the empiric antimicrobial therapy initiated, the regimen should be changed to an effective agent, irrespective of clinical response.
