What is the treatment for pregnant women with 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

Inpatient admission is warranted for any pregnant patient with pyelonephritis. The treatment of choice during pregnancy includes the use of beta-lactam antibiotics. Intravenous antibiotics should be administered until the patient is afebrile for 24 hours and symptomatically improved. It is recommended to avoid fluoroquinolones in pregnant patients. Aminoglycosides should also be avoided due to potential risk of ototoxicity following prolonged fetal exposure. See Table 4, below, for regimens for pyelonephritis in pregnant patients.

Table 4. Treatment of Pyelonephritis During Pregnancy (Open Table in a new window)

Mild to moderate pyelonephritis

  • Ceftriaxone (Rocephin) 1 g IV q24h or

  • Cefepime (Maxipime) 1 g IV q12h or

  • Cefotaxime (Claforan) 1-2 g IV q8h or

  • Ceftazidime (Fortaz, Tazicef) 2 g IV q8h or

  • Ampicillin 1-2 g IV q6h plus  gentamicin IV 1.5 mg/kg q8h

Severe pyelonephritis

If patient is immunocompromised and/or has incomplete urinary drainage:

  • Ticarcillin-clavulanate (Timentin) 3.1 g IV q6h or

  • Ampicillin-sulbactam (Unasyn) 1.5 g IV q6h or

  • Piperacillin-tazobactam (Zosyn) 3.375 g IV q6h

Once patients are afebrile for at least 48 hours, they can be switched to oral antibiotics, with the regimen choice guided by results from susceptibility studies, and discharged to complete 10-14 days of treatment. Obtain an additional urine culture 1-2 weeks after the completion of therapy to verify eradication of the infection. Obtain monthly urine cultures until delivery to monitor the urine for recurrent infection.


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