kiranmayi
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treatment for acute pyelonephritis?
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| usmle2004
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In women, acute uncomplicated pyelonephritis without accompanying clinical evidence of calculi or urologic disease is due to E. coli in most cases. Although the optimal route and duration of therapy have not been established, a 7- to 14-day course of a fluoroquinolone, an aminoglycoside, or a third-generation cephalosporin is usually adequate.
Neither ampicillin nor TMP-SMZ should be used as initial therapy because >25% of strains of E. coli causing pyelonephritis are now resistant to these drugs in vitro.
For at least the first few days of treatment, antibiotics should probably be given intravenously to most patients, but patients with mild symptoms can be treated for 7 to 14 days with an oral antibiotic (usually ciprofloxacin or ofloxacin), with or without an initial single parenteral dose.
In pregnancy, acute cystitis can be managed with 7 days of treatment with amoxicillin, nitrofurantoin, or a cephalosporin.
(adapted from Harrison)
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