Template:Pyelonephritis antibiotics: Difference between revisions

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(Add pediatric outpatient dosing section with oral cephalosporins and TMP/SMX)
 
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''Treatment is targeted at [[E. coli]], [[Enterococcus]], [[Klebsiella]], [[Proteus]], [[S. saprophyticus]]''
''Treatment is targeted at [[E. coli]], [[Enterococcus]], [[Klebsiella]], [[Proteus mirabilis]], [[S. saprophyticus]].''
====Outpatient====
====Outpatient====
''Consider one dose of [[Ceftriaxone]] 1g IV or [[Gentamycin]] 7mg/kg IV if the regional susceptibility of [[TMP/SMX]] or [[Fluoroquinolones]] is <80%''
''Consider one dose of [[Ceftriaxone]] 1g IV or [[Gentamicin]] 7mg/kg IV if the regional susceptibility of [[TMP/SMX]] or [[Fluoroquinolones]] is <80%''
*[[Ciprofloxacin]] 500mg BID x 7 days OR
*{{AntibioticDose|disease=Pyelonephritis|drug=Ciprofloxacin|dose=500mg PO BID x7 days|context=Outpatient}} '''OR'''
*[[Cefpodoxime]] 200 mg BID x10-14 days OR<ref>Colgan R, Williams M. Diagnosis and treatment of acute uncomplicated cystitis. Am Fam Physician. 2011 Oct 1;84(7):771-6.</ref>
*{{AntibioticDose|disease=Pyelonephritis|drug=Trimethoprim-Sulfamethoxazole DS|dose=160/800mg PO BID x14 days|context=Outpatient}} '''OR'''<ref>Gupta K, Hooton TM, Naber KG, et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women. Clinical Infectious Diseases. 2011;52(5):e103-e120. doi:10.1093/cid/ciq257</ref>
*[[Levofloxacin]] 750mg PO once x 7 days<ref>Sandberg T. et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012 Aug 4;380(9840):484-90.</ref>
*{{AntibioticDose|disease=Pyelonephritis|drug=Cephalexin|dose=500mg QID PO x 10-14 days (OR consider 1000mg BID)|context=Outpatient}} '''OR'''
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefdinir|dose=300mg BID PO x 10-14 days|context=Outpatient}} '''OR'''
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefpodoxime|dose=200mg PO BID x 10 days|context=Outpatient}} '''OR'''<ref>Colgan R, Williams M. Diagnosis and treatment of acute uncomplicated cystitis. Am Fam Physician. 2011 Oct 1;84(7):771-6.</ref>
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefixime|dose=400mg PO daily x 10 days|context=Outpatient}} '''OR'''<ref>Acute Pyelonephritis in Adults. Johnson, JR and Russo, TA. New England Journal of Medicine 2018; 378:48-59.</ref>
*{{AntibioticDose|disease=Pyelonephritis|drug=Levofloxacin|dose=750mg PO QD x7 days|context=Outpatient}}<ref>Sandberg T. et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012 Aug 4;380(9840):484-90.</ref>
====Adult Inpatient Options====
====Adult Inpatient Options====
*[[Ciprofloxacin]] 400mg IV q12hr OR
*{{AntibioticDose|disease=Pyelonephritis|drug=Ciprofloxacin|dose=400mg IV q12hr|context=Adult Inpatient}} '''OR'''
*[[Ceftriaxone]] 1gm IV QD OR
*{{AntibioticDose|disease=Pyelonephritis|drug=Ceftriaxone|dose=1gm IV QD|context=Adult Inpatient}} <span style="color:red">'''(Preferred in pregnancy)'''</span> '''OR'''
*Cefotaxime 1-2gm IV q8hr OR
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefotaxime|dose=1-2gm IV q8hr|context=Adult Inpatient}} '''OR'''
*[[Gentamicin]] 3mg/kg/day divided q8hr +/- ampicillin 1–2 gm q4hr OR
*{{AntibioticDose|disease=Pyelonephritis|drug=Gentamicin|dose=3mg/kg/day divided q8hr|context=Adult Inpatient}} +/- [[ampicillin]] 1–2 gm q4hr '''OR'''
*[[Piperacillin/Tazobactam]] 3.375 gm IV q6hr OR
*{{AntibioticDose|disease=Pyelonephritis|drug=Piperacillin/Tazobactam|dose=3.375 gm IV q6hr|context=Adult Inpatient}} '''OR'''
*[[Cefepime]] 2gm IV q8hr OR
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefepime|dose=2gm IV q8hr|context=Adult Inpatient}} '''OR'''
*[[Imipenem]] 500mg IV q8hr
*{{AntibioticDose|disease=Pyelonephritis|drug=Imipenem/Cilastatin|dose=500mg IV q8hr|context=Adult Inpatient}}


====Pediatric Outpatient Options====
*{{AntibioticDose|disease=Pyelonephritis|drug=Cephalexin|dose=25-50mg/kg/day PO divided q6-8h x 10-14 days (max 500mg/dose)|context=Pediatric Outpatient|population=Pediatric}} '''OR'''
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefixime|dose=8mg/kg PO daily x 10-14 days (max 400mg)|context=Pediatric Outpatient|population=Pediatric}} '''OR'''
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefdinir|dose=14mg/kg/day PO divided BID x 10 days (max 600mg/day)|context=Pediatric Outpatient|population=Pediatric}} '''OR'''
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefpodoxime|dose=10mg/kg/day PO divided BID x 10 days (max 200mg/dose)|context=Pediatric Outpatient|population=Pediatric}} '''OR'''
*{{AntibioticDose|disease=Pyelonephritis|drug=Trimethoprim-Sulfamethoxazole DS|display=TMP/SMX|dose=6-12mg/kg/day (TMP) PO divided BID x 10-14 days|context=Pediatric Outpatient|population=Pediatric}}
====Pediatric Inpatient Options====
====Pediatric Inpatient Options====
*[[Ceftriaxone]] 75mg/kg IV once daily
*{{AntibioticDose|disease=Pyelonephritis|drug=Ceftriaxone|dose=75mg/kg IV QD|context=Pediatric Inpatient|population=Pediatric}} '''OR'''
*[[Cefotaxime]] 50mg/kg IV q8hrs  
*{{AntibioticDose|disease=Pyelonephritis|drug=Cefotaxime|dose=50mg/kg IV q8hrs|context=Pediatric Inpatient|population=Pediatric}} '''OR'''
*[[Ampicillin]] 25mg/kg IV q6hrs + [[Gentamicin]] 2.5mg/kg IV q8hrs
*{{AntibioticDose|disease=Pyelonephritis|drug=Ampicillin|dose=25mg/kg IV q6hrs|context=Pediatric Inpatient|population=Pediatric}} '''+''' {{AntibioticDose|disease=Pyelonephritis|drug=Gentamicin|dose=2.5mg/kg IV q8hrs|context=Pediatric Inpatient|population=Pediatric|link=no}}
*{{AntibioticDose|drug=Ampicillin/Sulbactam|dose=3g IM/IV q6 hours x 14 days|context=UTI, Pyelonephritis|disease=Pyelonephritis|population=Adult}}

Latest revision as of 12:55, 20 March 2026

Treatment is targeted at E. coli, Enterococcus, Klebsiella, Proteus mirabilis, S. saprophyticus.

Outpatient

Consider one dose of Ceftriaxone 1g IV or Gentamicin 7mg/kg IV if the regional susceptibility of TMP/SMX or Fluoroquinolones is <80%

Adult Inpatient Options


Pediatric Outpatient Options

  • Cephalexin 25-50mg/kg/day PO divided q6-8h x 10-14 days (max 500mg/dose) OR
  • Cefixime 8mg/kg PO daily x 10-14 days (max 400mg) OR
  • Cefdinir 14mg/kg/day PO divided BID x 10 days (max 600mg/day) OR
  • Cefpodoxime 10mg/kg/day PO divided BID x 10 days (max 200mg/dose) OR
  • TMP/SMX 6-12mg/kg/day (TMP) PO divided BID x 10-14 days

Pediatric Inpatient Options

  1. ↑ Gupta K, Hooton TM, Naber KG, et al. International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women. Clinical Infectious Diseases. 2011;52(5):e103-e120. doi:10.1093/cid/ciq257
  2. ↑ Colgan R, Williams M. Diagnosis and treatment of acute uncomplicated cystitis. Am Fam Physician. 2011 Oct 1;84(7):771-6.
  3. ↑ Acute Pyelonephritis in Adults. Johnson, JR and Russo, TA. New England Journal of Medicine 2018; 378:48-59.
  4. ↑ Sandberg T. et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012 Aug 4;380(9840):484-90.
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