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{{Pyelonephritis}} | {{Pyelonephritis}} | ||
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==Overview== | ==Overview== | ||
Pyelonephritis can be prevented secondarily in some cases by giving long term prophylactic [[Antibiotic|antibiotics]]. Correction of a structural defect that leads to the initial episode of pyelonephritis may also be helpful in eliminating chances of recurrence of pyelonephritis. | |||
==Secondary Prevention== | ==Secondary Prevention== | ||
* If no abnormality is identified, some studies suggest long-term [[prophylaxis|preventative]] (prophylactic) treatment with antibiotics, either daily or after [[sexual intercourse]].<ref>{{cite journal |author=Schooff M, Hill K |title=Antibiotics for recurrent urinary tract infections |journal=American family physician |volume=71 |issue=7 |pages=1301-2 |year=2005 |pmid=15832532 |doi=}}</ref> | * If no structural or functional abnormality is identified, some studies suggest long-term [[prophylaxis|preventative]] (prophylactic) treatment with antibiotics, either daily or after [[sexual intercourse]].<ref>{{cite journal |author=Schooff M, Hill K |title=Antibiotics for recurrent urinary tract infections |journal=American family physician |volume=71 |issue=7 |pages=1301-2 |year=2005 |pmid=15832532 |doi=}}</ref> | ||
* In children at risk of recurrent UTIs, the evidence is inconclusive as to whether long-term prophylactic antibiotics are of use.<ref>{{cite journal |author=Williams GJ, Wei L, Lee A, Craig JC |title=Long-term antibiotics for preventing recurrent urinary tract infection in children |journal=Cochrane database of systematic reviews (Online) |volume=3 |issue= |pages=CD001534 |year=2006 |pmid=16855971 |doi=10.1002/14651858.CD001534.pub2}}</ref> | * In children at risk of recurrent [[UTI|UTIs]], the evidence is inconclusive as to whether long-term prophylactic antibiotics are of use.<ref>{{cite journal |author=Williams GJ, Wei L, Lee A, Craig JC |title=Long-term antibiotics for preventing recurrent urinary tract infection in children |journal=Cochrane database of systematic reviews (Online) |volume=3 |issue= |pages=CD001534 |year=2006 |pmid=16855971 |doi=10.1002/14651858.CD001534.pub2}}</ref> | ||
* Ingestion of cranberry juice has been studied as a prophylactic measure; while studies are heterogeneous, many suggest a benefit.<ref>{{cite journal |author=Raz R, Chazan B, Dan M |title=Cranberry juice and urinary tract infection |journal=Clin. Infect. Dis. |volume=38 |issue=10 |pages=1413-9 |year=2004 |pmid=15156480 |doi=10.1086/386328}}</ref> | * Ingestion of cranberry juice has been studied as a prophylactic measure; while studies are heterogeneous, many suggest a benefit.<ref>{{cite journal |author=Raz R, Chazan B, Dan M |title=Cranberry juice and urinary tract infection |journal=Clin. Infect. Dis. |volume=38 |issue=10 |pages=1413-9 |year=2004 |pmid=15156480 |doi=10.1086/386328}}</ref> | ||
===Antimicrobial Prophylaxis=== | |||
*Prophylaxis is required in individuals having two or more episodes of [[urinary tract infections]] in 6 months or three or more episodes in 12 months period.<ref name="pmid3333659">{{cite journal| author=Nicolle LE, Ronald AR| title=Recurrent urinary tract infection in adult women: diagnosis and treatment. | journal=Infect Dis Clin North Am | year= 1987 | volume= 1 | issue= 4 | pages= 793-806 | pmid=3333659 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3333659 }} </ref><ref name="pmid3077293">{{cite journal| author=Ronald AR, Conway B| title=An approach to urinary tract infections in ambulatory women. | journal=Curr Clin Top Infect Dis | year= 1988 | volume= 9 | issue= | pages= 76-125 | pmid=3077293 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3077293 }} </ref> | |||
*Prophylactic therapy using antimicrobial agents may be considered as either continuously or postcoital prophylaxis for 6 to 12 months. | |||
*The following regimens may be used as single doses prior to sexual activity.<ref name="pmid21292654">{{cite journal| author=Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG et al.| title=International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 5 | pages= e103-20 | pmid=21292654 | doi=10.1093/cid/ciq257 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21292654 }} </ref> | |||
*'''Prophylactic Therapy''': | |||
:*Preferred regimen (1): [[Fosfomycin]] tromethamine 3 g PO in a single dose | |||
:*Preferred regimen (2): [[Nitrofurantoin]] monohydrate/macrocrystals 100 mg PO in a single dose | |||
:*Preferred regimen (3): [[Trimethoprim-Sulfamethoxazole]] 160/800 mg PO double-strength tablet bid in a single dose | |||
:*Preferred regimen (4): [[Trimethoprim]] 100 mg PO bid in a single dose | |||
:*Alternative regimen (1): [[Ciprofloxacin]] 250 mg PO bid in a single dose | |||
:*Alternative regimen (2): [[Levofloxacin]] 250 mg PO qd in a single dose | |||
:*Alternative regimen (3): [[Norfloxacin]] 400 mg PO bid in a single dose | |||
:*Alternative regimen (4): [[Gatifloxacin]] 200 mg PO qd in a single dose | |||
*Post-Coital [[Ciprofloxacin]] has been found to be similar in effect to daily [[Ciprofloxacin]].<ref name="pmid9072603">{{cite journal| author=Melekos MD, Asbach HW, Gerharz E, Zarakovitis IE, Weingaertner K, Naber KG| title=Post-intercourse versus daily ciprofloxacin prophylaxis for recurrent urinary tract infections in premenopausal women. | journal=J Urol | year= 1997 | volume= 157 | issue= 3 | pages= 935-9 | pmid=9072603 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9072603 }} </ref> | |||
*[[Nitrofurantoin]] and [[Fosfomycin]] effective for use as long term prophylaxis.<ref name="pmid9786476">{{cite journal| author=Brumfitt W, Hamilton-Miller JM| title=Efficacy and safety profile of long-term nitrofurantoin in urinary infections: 18 years' experience. | journal=J Antimicrob Chemother | year= 1998 | volume= 42 | issue= 3 | pages= 363-71 | pmid=9786476 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9786476 }} </ref><ref name="pmid16080282">{{cite journal| author=Rudenko N, Dorofeyev A| title=Prevention of recurrent lower urinary tract infections by long-term administration of fosfomycin trometamol. Double blind, randomized, parallel group, placebo controlled study. | journal=Arzneimittelforschung | year= 2005 | volume= 55 | issue= 7 | pages= 420-7 | pmid=16080282 | doi=10.1055/s-0031-1296881 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16080282 }} </ref> | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Medicine]] | |||
[[Category:Infectious disease]] | |||
[[Category:Nephrology]] | |||
[[Category:Urology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Emergency medicine]] | |||
Latest revision as of 23:54, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
Overview
Pyelonephritis can be prevented secondarily in some cases by giving long term prophylactic antibiotics. Correction of a structural defect that leads to the initial episode of pyelonephritis may also be helpful in eliminating chances of recurrence of pyelonephritis.
Secondary Prevention
- If no structural or functional abnormality is identified, some studies suggest long-term preventative (prophylactic) treatment with antibiotics, either daily or after sexual intercourse.[1]
- In children at risk of recurrent UTIs, the evidence is inconclusive as to whether long-term prophylactic antibiotics are of use.[2]
- Ingestion of cranberry juice has been studied as a prophylactic measure; while studies are heterogeneous, many suggest a benefit.[3]
Antimicrobial Prophylaxis
- Prophylaxis is required in individuals having two or more episodes of urinary tract infections in 6 months or three or more episodes in 12 months period.[4][5]
- Prophylactic therapy using antimicrobial agents may be considered as either continuously or postcoital prophylaxis for 6 to 12 months.
- The following regimens may be used as single doses prior to sexual activity.[6]
- Prophylactic Therapy:
- Preferred regimen (1): Fosfomycin tromethamine 3 g PO in a single dose
- Preferred regimen (2): Nitrofurantoin monohydrate/macrocrystals 100 mg PO in a single dose
- Preferred regimen (3): Trimethoprim-Sulfamethoxazole 160/800 mg PO double-strength tablet bid in a single dose
- Preferred regimen (4): Trimethoprim 100 mg PO bid in a single dose
- Alternative regimen (1): Ciprofloxacin 250 mg PO bid in a single dose
- Alternative regimen (2): Levofloxacin 250 mg PO qd in a single dose
- Alternative regimen (3): Norfloxacin 400 mg PO bid in a single dose
- Alternative regimen (4): Gatifloxacin 200 mg PO qd in a single dose
- Post-Coital Ciprofloxacin has been found to be similar in effect to daily Ciprofloxacin.[7]
- Nitrofurantoin and Fosfomycin effective for use as long term prophylaxis.[8][9]
References
- ↑ Schooff M, Hill K (2005). "Antibiotics for recurrent urinary tract infections". American family physician. 71 (7): 1301–2. PMID 15832532.
- ↑ Williams GJ, Wei L, Lee A, Craig JC (2006). "Long-term antibiotics for preventing recurrent urinary tract infection in children". Cochrane database of systematic reviews (Online). 3: CD001534. doi:10.1002/14651858.CD001534.pub2. PMID 16855971.
- ↑ Raz R, Chazan B, Dan M (2004). "Cranberry juice and urinary tract infection". Clin. Infect. Dis. 38 (10): 1413–9. doi:10.1086/386328. PMID 15156480.
- ↑ Nicolle LE, Ronald AR (1987). "Recurrent urinary tract infection in adult women: diagnosis and treatment". Infect Dis Clin North Am. 1 (4): 793–806. PMID 3333659.
- ↑ Ronald AR, Conway B (1988). "An approach to urinary tract infections in ambulatory women". Curr Clin Top Infect Dis. 9: 76–125. PMID 3077293.
- ↑ Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG; et al. (2011). "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clin Infect Dis. 52 (5): e103–20. doi:10.1093/cid/ciq257. PMID 21292654.
- ↑ Melekos MD, Asbach HW, Gerharz E, Zarakovitis IE, Weingaertner K, Naber KG (1997). "Post-intercourse versus daily ciprofloxacin prophylaxis for recurrent urinary tract infections in premenopausal women". J Urol. 157 (3): 935–9. PMID 9072603.
- ↑ Brumfitt W, Hamilton-Miller JM (1998). "Efficacy and safety profile of long-term nitrofurantoin in urinary infections: 18 years' experience". J Antimicrob Chemother. 42 (3): 363–71. PMID 9786476.
- ↑ Rudenko N, Dorofeyev A (2005). "Prevention of recurrent lower urinary tract infections by long-term administration of fosfomycin trometamol. Double blind, randomized, parallel group, placebo controlled study". Arzneimittelforschung. 55 (7): 420–7. doi:10.1055/s-0031-1296881. PMID 16080282.