Related article: FDA Warnings for Fluoroquinolones.

A) Fluoroquinolone is the first-line treatment for mild and moderate pyelonephritis [If local rates of E. coli fluoroquinolone resistance are low (< 10%)]:

  • Ciprofloxacin 500 mg PO twice daily x 7 d
  • Ciprofloxacin extended-release 1000 mg PO x 7 d
  • Levofloxacin 750 mg orally x 5-7 d

B) If fluoroquinolone resistance is >10%, start with an initial dose of a parenteral agent. Then complete treatment as guided by antimicrobial sensitivity results.

If the community fluoroquinolone resistance rate exceeds 10%, a one-time dose of a parenteral antimicrobial such as ceftriaxone or a consolidated dose of an aminoglycoside should be given, followed by an oral fluoroquinolone regimen.

  • Ceftriaxone 1 gm IM or IV x 1
  • Gentamicin 5 mg/kg IM or IV x 1

C) Modify initial treatment based upon results of urine culture and sensitivity.

  • Oral beta-lactams are second-line agents due to high rates of relapse (even when the pathogen is susceptible).

Reference

Am Fam Physician. 2011 Sep 1;84(5):519-526. http://www.aafp.org/afp/2011/0901/p519.html

IDSA Guidelines 2011

https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540458/all/Pyelonephritis__Acute__Uncomplicated

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