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.[1]
- 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 intravenous 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[2], meropenem-vaborbactam[3], and imipenem-cilastatin-relebactam.[4][5]
- After treating the infection, additional investigations are required to find the cause of the obstruction e.g., nephrolithiasis, tumors etc. for definitive treatment.
References
- ↑ Ludvigson AE, Beaule LT (2016). "Urologic Emergencies". Surg Clin North Am. 96 (3): 407–24. doi:10.1016/j.suc.2016.02.001. PMID 27261785.
- ↑ Wagenlehner FM, Umeh O, Steenbergen J, Yuan G, Darouiche RO (2015). "Ceftolozane-tazobactam compared with levofloxacin in the treatment of complicated urinary-tract infections, including pyelonephritis: a randomised, double-blind, phase 3 trial (ASPECT-cUTI)". Lancet. 385 (9981): 1949–56. doi:10.1016/S0140-6736(14)62220-0. PMID 25931244.
- ↑ Dhillon S (2018). "Meropenem/Vaborbactam: A Review in Complicated Urinary Tract Infections". Drugs. 78 (12): 1259–1270. doi:10.1007/s40265-018-0966-7. PMC 6132495. PMID 30128699.
- ↑ Kuiper SG, Leegwater E, Wilms EB, van Nieuwkoop C (2020). "Evaluating imipenem + cilastatin + relebactam for the treatment of complicated urinary tract infections". Expert Opin Pharmacother. 21 (15): 1805–1811. doi:10.1080/14656566.2020.1790525. PMID 32820669 Check
|pmid=value (help). - ↑ Doi Y (2019). "Treatment Options for Carbapenem-resistant Gram-negative Bacterial Infections". Clin Infect Dis. 69 (Suppl 7): S565–S575. doi:10.1093/cid/ciz830. PMC 6853760 Check
|pmc=value (help). PMID 31724043.