When is outpatient treatment indicated for acute pyelonephritis?

Updated: Jul 01, 2021
  • Author: Tibor Fulop, MD, PhD, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Answer

Outpatient treatment is appropriate for patients who have an uncomplicated infection that does not warrant hospitalization. Oral antibiotics are used to treat patients with mild to moderate illness. (See Table 2, below, for a description of outpatient treatments for pyelonephritis.)

Table 2. Outpatient Treatment for Pyelonephritis (Open Table in a new window)

First-line therapy

  • Ciprofloxacin (Cipro) 500 mg PO BID for 7d or

  • Ciprofloxacin extended-release (Cipro XR) 1000 mg PO daily for 7d or

  • Levofloxacin (Levaquin) 750 mg PO daily for 5d

  • If fluoroquinolone resistance is thought to be >10%, administer a single dose of ceftriaxone (Rocephin) 1g IV or  a consolidated 24-hour dose of an aminoglycoside (gentamicin 7 mg/kg IV or  tobramycin 7 mg/kg IV or amikacin 20 mg/kg IV)

Second-line therapy

  • Trimethoprim/sulfamethoxazole* 160 mg/800 mg (Bactrim DS, Septra DS) 1 tablet PO BID for 14d

  • If trimethoprim/sulfamethoxazole is used when the susceptibility is not known, an initial single IV dose of the following may also be given: ceftriaxone 1 g IV or  a consolidated 24-h dose of an aminoglycoside (gentamicin 7 mg/kg IV or  tobramycin 7 mg/kg IV or amikacin 20 mg/kg IV)

Alternative therapy

  • Oral beta-lactams are not as effective for treating pyelonephritis; however, if they are used, administer with a single dose of ceftriaxone 1 g IV or  a consolidated 24-h dose of an aminoglycoside (gentamicin 7 mg/kg IV or  tobramycin 7 mg/kg IV or amikacin 20 mg/kg IV)

  • Amoxicillin-clavulanate (Augmentin) 500 mg/125 mg PO BID for 14d or

  • Amoxicillin-clavulanate 250 mg/125 mg PO TID for 3-7d or

  • Cefaclor 500 mg PO TID for 7d

*Should generally be avoided in elderly patients because of the risk of affecting kidney function.

 


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