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Pyelonephritis Organism-Specific Therapy

Updated: Aug 18, 2020

Author: Amy A Yau, MD; Chief Editor: Thomas E Herchline, MD

Specific Organisms and Therapeutic Regimens

Organism-specific therapeutic regimens for pyelonephritis are provided below, including those for the following [1, 2, 3, 4, 5, 6, 7, 8, 9]

Escherichia coli
Staphylococcus saprophyticus
Staphylococcus aureus
Proteus species (spp)
Klebsiella spp
Enterococcus spp

Antibiotics are listed in no particular order. The treating clinician should take local resistance patterns into account when selecting an antibiotic. Therapy should be tailored, if necessary, once sensitivities are available.

E coli

Oral options include the following:

Ciprofloxacin 500 mg q12hr or
Ciprofloxacin Extended Release 1000 mg PO daily or
Levofloxacin 750 mg PO daily or
Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12hr or
Cefuroxime 750 mg PO q8hr or
Cefixime 400 mg PO daily or
Cefpodoxime 200 mg PO q12hr

Intravenous options include the following:

Ceftriaxone 1g IV q24hr or
Ciprofloxacin 400 mg IV q12hr or
Levofloxacin 750 mg IV q24hr or
Piperacillin/tazobactam 3.375-4.5 g IV q6hr or
Meropenem 1 g IV q8hr or
Ertapenem 1 g IV q24hr

S saprophyticus

Oral options include the following:

Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12hr or
Amoxicillin/clavulanate (875 mg/125 mg) 1 tablet PO q12hr

The intravenous option is as follows:

Ampicillin/sulbactam 3 g IV q6hr

S aureus

Oral options include the following:

Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12hr or
Amoxicillin/clavulanate (875 mg/125 mg) 1 tablet PO q12hr

The intravenous option is as follows:

Ampicillin/sulbactam 3 g IV Q6H

Proteus spp

Oral options include the following:

Ciprofloxacin 500 mg PO q12hr or
Levofloxacin 750 mg PO daily or
Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12hr

Intravenous options include the following:

Ceftriaxone 1g IV q24hr or
Ciprofloxacin 400 mg IV q12hr or
Levofloxacin 750 mg IV q24hr or
Piperacillin/tazobactam 3.375-4.5 g q6hr or
Meropenem 1 g IV q8hr or
Ertapenem 1 g IV q24hr

Klebsiella spp

Oral options include the following:

Ciprofloxacin 500 mg PO q12hr or
Levofloxacin 750 mg PO daily

Intravenous options include the following:

Ciprofloxacin 400 mg IV q12hr or
Levofloxacin 750 mg IV q24hr or
Ceftriaxone 1 g IV q24hr or
Cefepime 1-2 g IV q8-12hr or
Imipenem 500 mg IV q6hr or
Ertapenem 1 g IV q24hr or
Meropenem 1 g IV q8hr

Enterococcus spp

Oral options include the following:

Amoxicillin 500 mg PO q8hr or
Amoxicillin/clavulanate 875/125 mg BID or
Cefixime 400 mg PO daily or
Cefpodoxime 200 mg PO BID

Intravenous options include the following:

Ampicillin 2 g IV q4hr or
Piperacillin/Tazobactam 3.375-4.5 g q6hr or
Ceftriaxone 1g IV q24hr or
Cefepime 1-2 g IV q8-12hr or
Ceftolozane-tazobactam 1.5g IV q8hr or
Ceftazidime-avibactam 2.5 g IV q8hr or
Meropenem 1 g IV q8hr or
Gentamicin 5.0-7.5 mg/kg body weight IV q24hr

Author

Amy A Yau, MD Clinical Assistant Professor of Medicine, University of Arizona College of Medicine

Amy A Yau, MD is a member of the following medical societies: American College of Physicians

Disclosure: Nothing to disclose.

Coauthor(s)

Edgar V Lerma, MD, FACP, FASN, FAHA, FASH, FNLA, FNKF Clinical Professor of Medicine, Section of Nephrology, Department of Medicine, University of Illinois at Chicago College of Medicine; Research Director, Internal Medicine Training Program, Advocate Christ Medical Center; Consulting Staff, Associates in Nephrology, SC

Edgar V Lerma, MD, FACP, FASN, FAHA, FASH, FNLA, FNKF is a member of the following medical societies: American Heart Association, American Medical Association, American Society of Hypertension, American Society of Nephrology, Chicago Medical Society, Illinois State Medical Society, National Kidney Foundation, Society of General Internal Medicine

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Astra Zeneca<br/>Author for: UpToDate, ACP Smart Medicine, Elsevier, McGraw-Hill, Wolters Kluwer.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Thomas E Herchline, MD Professor of Medicine, Wright State University, Boonshoft School of Medicine; Medical Consultant, Public Health, Dayton and Montgomery County (Ohio) Tuberculosis Clinic

Thomas E Herchline, MD is a member of the following medical societies: Alpha Omega Alpha, Infectious Diseases Society of America, Infectious Diseases Society of Ohio

Disclosure: Received research grant from: Regeneron.

Additional Contributors

Mony Fraer, MD, MHCDS, FACP, FASN Associate Professor, Division of Nephrology, Department of Medicine, University of Iowa Hospitals and Clinics; Staff Physician, Iowa City Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Acknowledgements

Kelley Struble, DO Fellow, Department of Infectious Diseases, University of Oklahoma College of Medicine

Kelley Struble, DO is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.