Which antibiotics are indicated for ADPKD patients with UTI?
UTIs in ADPKD patients should be treated promptly because they may be complicated with septic shock or perirenal abscess and accelerate its progression to ESKD. Most UTI in patients with ADPKD are caused by Enterobacteriaceae. Intravenous antibiotics are needed initially for presentations with sepsis, acute pyelonephritis, or cyst infection, and the choice of antibiotics is dictated by antimicrobial susceptibilities whenever possible. Switching to oral antibiotics with good penetration into the cysts, such as quinolones and trimethoprim-sulfamethoxazole, can be considered after an initial favorable response with resolution of fever and pain. Prolonged antibiotic treatment for several weeks may be needed to eradicate the infection. Complications (e.g., obstruction, cyst infection, or infected stone) need to be excluded if there are relapses after completing antibiotic therapy. Percutaneous or surgical drainage may be required in some cases.
