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Acute Pyelonephritis, Outpatient
Preferred Regimen
▸
Ciprofloxacin
500 mg PO q12h x 7 days
±
Ciprofloxacin
400 mg IV x 1 dose
OR
▸
Ciprofloxacin
XR 1000 mg PO q24h for 7 days
OR
▸
Levofloxacin
750 mg PO q24h for 5 days
PLUS
(if fluoroquinolone resistance >10%)
▸
Ceftriaxone
1 g IV x 1 dose
OR
▸
Gentamicin
7 mg/kg IV x 1 dose
OR
▸
Tobramycin
7 mg/kg IV x 1 dose
OR
▸
Amikacin
20 mg/kg IV x 1 dose
Alternative Regimen 1
▸
TMP/SMZ
160/800 mg PO q12h x 14 days
PLUS
(if TMP/SMZ resistance unknown)
▸
Ceftriaxone
1 g IV x 1 dose
OR
▸
Gentamicin
7 mg/kg IV x 1 dose
OR
▸
Tobramycin
7 mg/kg IV x 1 dose
OR
▸
Amikacin
20 mg/kg IV x 1 dose
Alternative Regimen 2
▸
Amoxicillin–Clavulanate
500/125 mg PO q12h x 14 days
OR
▸
Amoxicillin–Clavulanate
250/125 mg PO q8h x 5–7 days
OR
▸
Cefaclor
500 mg PO q8h x 7 days
PLUS
▸
Ceftriaxone
1 g IV x 1 dose
OR
▸
Gentamicin
7 mg/kg IV x 1 dose
OR
▸
Tobramycin
7 mg/kg IV x 1 dose
OR
▸
Amikacin
20 mg/kg IV x 1 dose
Acute Pyelonephritis, Inpatient
Preferred Regimen
▸
Ciprofloxacin
400 mg IV q12h
OR
▸
Levofloxacin
750 mg IV q24h
OR
▸
Gentamicin
5–7 mg/kg IV q24h
OR
▸
Ceftriaxone
1–2 gm IV q24h
OR
▸
Cefotaxime
2 gm IV q8h
OR
▸
Piperacillin/Tazobactam
3.375 gm IV q4–6h
OR
▸
Ertapenem
1 gm IV q24h
OR
▸
Doripenem
500 mg IV q8h
The choice of antiobiotics should be based on resistance pattern.
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