Pyonephrosis medical therapy

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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, 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 that 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^[1], meropenem-vaborbactam^[2], and imipenem-cilastatin-relebactam.^[3]