Pyonephrosis medical therapy: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
|||
| Line 4: | Line 4: | ||
==Medical therapy== | ==Medical therapy== | ||
* Pyonephrosis is a urological emergency. | |||
* Hemodynamically unstable patients may require aggressive fluid resuscitation with crystalloids and pressor agent (dopamine) to maintain adequate blood pressure. | |||
* Before initiating antimicrobial treatment for suspected pyonephrosis, a urine and blood culture and susceptibility test should always be performed. | |||
* All patients with pyonephrosis should be empirically treated with long-acting, broad spectrum antibiotics which may be later narrowed based on culture report. | |||
* Presence of pyonephrosis and obstruction reduces the efficacy and penetration of antibiotics. Therefore, drainage of the pus should be done immediately after administering the antibiotics. | |||
* Intravenous Ampicillin + Gentamicin is a good initial option which covers both gram positive and negative organisms. | |||
* Anaerobic coverage with Clindamycin, antifungal or antitubercular agents may be required depending upon the clinical scenario. | |||
* Carbapenem-resistant enterobacteriaceae can be treated with ceftazidime-avibactam, ceftolozane-tazobactam, meropenem-vaborbactam, imipenem-cilastatin-relebactam, plazomicin, eravacycline, and cefiderocol. | |||
==References== | ==References== | ||
Revision as of 06:00, 17 October 2021
|
Pyonephrosis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Pyonephrosis medical therapy On the Web |
|
American Roentgen Ray Society Images of Pyonephrosis medical therapy |
|
Risk calculators and risk factors for Pyonephrosis medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Harsh Vardhan Chawla, M.B.B.S.[2]
Medical therapy
- Pyonephrosis is a urological emergency.
- Hemodynamically unstable patients may require aggressive fluid resuscitation with crystalloids and pressor agent (dopamine) to maintain adequate blood pressure.
- Before initiating antimicrobial treatment for suspected pyonephrosis, a urine and blood culture and susceptibility test should always be performed.
- All patients with pyonephrosis should be empirically treated with long-acting, broad spectrum antibiotics which may be later narrowed based on culture report.
- Presence of pyonephrosis and obstruction reduces the efficacy and penetration of antibiotics. Therefore, drainage of the pus should be done immediately after administering the antibiotics.
- Intravenous Ampicillin + Gentamicin is a good initial option which covers both gram positive and negative organisms.
- Anaerobic coverage with Clindamycin, antifungal or antitubercular agents may be required depending upon the clinical scenario.
- Carbapenem-resistant enterobacteriaceae can be treated with ceftazidime-avibactam, ceftolozane-tazobactam, meropenem-vaborbactam, imipenem-cilastatin-relebactam, plazomicin, eravacycline, and cefiderocol.