What is the duration of inpatient antibiotic therapy for 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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Answer

Duration of therapy should be at least 10-14 days, inclusive of initial IV therapy. Patient circumstances may warrant more prolonged therapy.

The PROGRESS (Procalcitonin-guided Antimicrobial Therapy to Reduce Long-Term Sequelae of Infections) study found that in septic patients, procalcitonin levels can be used to guide discontinuation of antibiotics. This multicenter randomized trial in 266 patients, 95 of whom had acute pyelonephritis, used an ≥80% reduction in procalcitonin level or any procalcitonin level of ≤0.5 μg/L at Day 5 or later as a criterion for discontinuing antibiotics. [40]

In PROGRESS, procalcitonin-guided discontinuation, compared with standard of care, resulted in a shorter median length of antibiotic therapy (5 versus 10 days), a lower rate of infection-associated adverse events such as infections by multidrug-resistant organisms and Clostridioides difficile (7.2% versus 15.3%), and lower 28-day mortality (15.2% versus 28.2%). The cost of hospitalization was also reduced in the procalcitonin arm. [40]


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