How is pyelonephritis treated during pregnancy?

Updated: Nov 04, 2020
  • Author: Mony Fraer, MD, MHCDS, FACP, FASN; Chief Editor: Thomas E Herchline, MD  more...
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Inpatient admission is warranted for any pregnant patient with pyelonephritis. Avoid fluoroquinolones and aminoglycosides in pregnant patients.

Antibiotic selection should be based on urine culture sensitivities, if known. Often, therapy must be initiated on an empirical basis, before culture results are available. This requires clinical knowledge of the most common organisms and their practice-specific or hospital-specific sensitivities to medications.

Institution-specific drug resistances should also be considered before a treatment antibiotic is chosen. For instance, with E coli infection alone, resistance to ampicillin can be as high as 28%-39%. Resistance to trimethoprim-sulfamethoxazole has been described as 31%, and resistance to first-generation cephalosporins may be as high as 9-19%.

Therapy should be given for 24-48h or until severe symptoms improve. Duration of therapy should be 10-14d, inclusive of initial IV therapy.

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