Which antibiotics are used for the treatment of complicated acute pyelonephritis (kidney infection)?

Updated: Jul 01, 2021
  • Author: Tibor Fulop, MD, PhD, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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With complicated acute pyelonephritis, treat patients parenterally until defervescence and improvement in the clinical condition warrants changing to oral antibiotics. Complete the course of therapy with an oral agent selected on the basis of culture results. [28] Acceptable regimens include the following:

  • Ampicillin and an aminoglycoside
  • Cefepime
  • Imipenem
  • Meropenem
  • Piperacillin-tazobactam
  • Ticarcillin-clavulanate
  • Ceftazidime-avibactam [31, 32]
  • Meropenem-vaborbactam

If the patient is allergic to penicillin, vancomycin should be substituted. Vancomycin or linezolid are options if enterococci are a consideration.

Meropenem-vaborbactam (Vabomere) is a combination of the carbapenem antibiotic meropenem with the beta-lactamase inhibitor vaborbactam. Specifically, vaborbactam inhibits bacterial production of the Klebsiella pneumoniae carbapenemase (KPC) enzyme, which confers resistance to carbapenems. The US Food and Drug Administration (FDA) has approved meropenem-vaborbactam for adults aged 18 years and older with pyelonephritis and other complicated urinary tract infections (UTIs) caused by designated susceptible Enterobacteriaceae: Escherichia coliK pneumoniae, and Enterobacter cloacae species complex. [33]

The safety and efficacy of meropenem-vaborbactam were demonstrated in a study of more than 500 adults with complicated UTI, including pyelonephritis, in which cure or improvement in symptoms and a negative urine culture were seen in about 98% of patients treated with meropenem-vaborbactam, versus about 94% of patients treated with piperacillin–tazobactam. Approximately 7 days after completing treatment, about 77% of patients treated with meropenem-vaborbactam demonstrated resolution of symptoms and a negative urine culture, compared with about 73% of patients treated with piperacillin–tazobactam. [33]

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