Fast Five Quiz: Are You Prepared to Confront Pyelonephritis?

Vecihi Batuman, MD

Disclosures

February 26, 2018

Patients presenting with acute pyelonephritis can be treated with a single dose of a parenteral antibiotic followed by oral therapy, provided they are monitored within the first 48 hours.

Antibiotic selection is typically empirical because the results of blood or urine cultures are rarely available by the time a decision must be made. Initial selection should be guided by local antibiotic resistance patterns. Culture results from specimens collected before the initiation of therapy should be checked in 48 hours to determine antibiotic efficacy. Because of the high rate of resistance of E coli, the empirical use of trimethoprim-sulfamethoxazole should be avoided in patients who require hospitalization.

For renal cortical abscesses (renal carbuncles), surgical drainage was once the only treatment. However, modern antibiotics alone often are curative. A semisynthetic penicillin, cephalosporin, fluoroquinolone, or vancomycin is recommended. Generally, parenteral antibiotics should be administered for 10-14 days, followed by oral therapy for 2-4 weeks. Fever should resolve within 5-6 days, and pain should resolve within 24 hours. If parenteral antibiotic therapy is successful, oral therapy is instituted for an additional 2-4 weeks.

For more on the treatment of acute pyelonephritis, read here.

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