Treatment
Use local sensitivities to guide your selection of empiric antibiotic regimen.
Outpatient Treatment
-Ciprofloxacin 500 mg PO twice daily for 7 days
-Levofloxacin 750 mg PO once daily for 5 days.
-Bactrim DS 1 tab PO twice daily for 14 days.
-Cephalexin 500 mg PO four times daily for 10-14 days.
Related article: Pyelonephritis outpatient treatment.
Inpatient Treatment
Start with IV and then switch to PO when the patient is afebrile and cultures have come back.
If you Don’t suspect enterococcus infection
Options are:
Ceftriaxone 1g IV once daily
Levofloxacin 750 mg IV once daily
Ciprofloxacin 400 mg IV twice daily
Cefepime 1g IV three times daily (provides pseudomonas coverage)
Imipenem 500 mg IV four times daily
Aztreonam 2g IV three times daily (if severe PCN allergy or recent fluoroquinolone treatment).
If you suspect enterococcus infection, options are one of the following:
Ampicillin 2g IV four times daily and Gentamycin 1mg/kg IV three times daily
Piperacillin/tazobactam 4.5g IV three times daily
Ampicillin/sulbactam 3g IV four times daily.
*Admit all pregnant women with pyelonephritis.