Pyelonephritis treatment

It is known that an association exists between maternal UTI during pregnancy and fetal death, mental retardation, and developmental delay.24 Because of this known association, and because up to 7% of pregnant women have an asymptomatic bacteriuria that may progress to pyelonephritis, screening is necessary. In patients with significant bacteriuria, whether symptomatic or asymptomatic, treatment is recommended to avoid the complications discussed above. In the majority... 

Warren JW, Abrutyn E, Hebei JR, et al. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis. Clin Infect Dis 1999 29 745-758. 

Treatment of asymptomatic bacteriuria is necessary to reduce the risk of pyelonephritis and premature delivery. A course of 7 to 10 days of treatment is common. A repeat culture 10 days after completion of treatment is recommended. 

Pediatric patients (2 months to 16 years of age) - Treatment of uncomplicated and complicated urinary tract infections (including pyelonephritis), uncomplicated skin and skin structure infections, pneumonia, and as empiric therapy for febrile neutropenic patients. 

Levofloxacin (1), the levo-isomer or the (5)-enantiomer of ofloxacin, received FDA approval in 1996 (Fish, 2003 Hurst et al., 2002 Mascaretti, 2003 Norrby, 1999 North et al., 1998). The initial approval covered community-acquired pneumonia, acute bacterial exacerbation of chronic bronchitis, acute maxillary sinusitis, uncomplicated skin and skin structure infections, acute pyelonephritis, and complicated urinary tract infections (North et al., 1998). Four years later, the levofloxacin indication list grew to include community-acquired pneumonia caused by penicillin-resistant Streptococcus pneumoniae. In addition, in 2002, nosocomial (hospital-acquired) pneumonia caused by methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Haemophilus influenzae, Kliebsella pneumoniae, and Escherichia coli was added (Hurst et al., 2002). Finally in 2004, LVX was approved as a post-exposure treatment for individuals exposed to Bacillus anthracis, the microbe that causes anthrax, via inhalation (FDA, 2004). 

It is the levoisomer of ofloxacin and having better activity than ciprofloxacin and ofloxacin against S. pneumoniae. It is also used in chronic bronchitis, sinusitis, pyelonephritis, and other related infections of soft tissues. Due to high oral bioavailability, patient can be shifted from IV to oral therapy. It can be administered just once a day regimen as an alternate to other fluoroquinolones in the treatment of respiratory infections. 

Getttamidtt. Gentamicin is widely used in the treatment of severe infections. Uses include septicemia, neonatal sepsis, neonatal meningitis, biliary tract infection, pyelonephritis, prostatitis, and endocarditis. Gentamicin is frequently used for empiric therapy in presmned gramnegative bacillary infections before the identification and susceptibility of the causative organism are known. Patients with cystic fibrosis and those in intensive care imits often have Pseudomonas infections and are typically treated with gentamicin. 

Isepamicin is similar to amikacin but has better activity against strains that produce type I 6 -acetyltransferase. It can cause nephrotoxicity, vestibular toxicity, and ototoxicity. However, it is one of the less toxic of the aminoglycosides (1). The antibacterial spectrum of isepamicin includes Enterobacteriaceae and staphylococci anaerobes, Neisseriae, and streptococci are resistant (1). Isepamicin was as effective and safe as amikacin in the treatment of acute pyelonephritis in children and might prove an advantageous alternative in areas with a high incidence of resistance to other aminoglycosides (2). 

Kafetzis DA, Maltezou HC, Mavrikou M, Siafas C, Paraskakis I, Delis D, Bartsokas C. Isepamicin versus amikacin for the treatment of acute pyelonephritis in children. Int J Antimicrob Agents 2000 14(l) 51-5. 

In comparative trials involving commonly used regimens, levofloxacin had equivalent if not greater activity in the treatment of community-acquired pneumonia, acute bacterial exacerbations of chronic bronchitis, acute bacterial sinusitis, acute pyelonephritis, and complicated urinary tract infection (5). 

Cronberg S, Banke S, Bergman B, Boman H, Eilard T, Elbel E, Hugo-Persson M, Johansson E, Kuylenstierna N, Lanbeck P, Lindblom A, Paulsen O, Schonbeck C, Walder M, Wieslander P. Fewer bacterial relapses after oral treatment with norfloxacin than with ceftibuten in acute pyelonephritis initially treated with intravenous cefur-oxime. Scand J Infect Dis 2001 33(5) 339-43. 

Tetracyclines are removed by hemodialysis, but significantly less than creatinine or urea (100,116). Severe adverse effects of tetracyclines occur almost exclusively with doses over 1.0 g/day (101) or in the treatment of pyelonephritis with concomitant renal insufficiency. 

Davis GJ, McKenzie BE. Toxicologic evaluation of ofloxacin. The American journal of medicine. 1989 Dec 29 87(6C) 43S-6S. MoutonY, Ajana F,ChidiacC,CapronMH, Home P,Masquelier AM. A multicenter study of lomefloxacin and trimethoprim/sulfam-ethoxazole in the treatment of uncomplicated acute pyelonephritis.The American journal of medicine. 1992 Apr 6 92(4A) 87S-... 

What are appropriate antibiotics that can be used for the treatment of pyelonephritis ... 

The infecting organisms causing pyelonephritis are typically similar to the infecting pathogens responsible for lower UTIs. In uncomplicated cases, antibiotics used for treatment of lower tract Infections also can be used for the treatment of upper tract infections. These agents typically include fluoroquinolones and TMP-SMX. In more serious cases, pyelonephritis may be accompanied by bacteremia, warranting hospitalization and parenteral therapy. 

Cox CE, Marbury TC, Pittman WG, et al. A randomized, double-bhnd, multicenter comparison of gatifloxacin versus ciprofloxacin in die treatment of complicated urinary tract infection and pyelonephritis. Chn Ther... 

Ertapenem is a carbapenem that inhibits cell wall synthesis. It is indicated in the treatment of moderate to severe complicated intra-abdominal infections, complicated skin and skin structure infections, community-acquired pneumonia, complicated urinary tract infections (UTIs) (including pyelonephritis), and acute pelvic infections (including postpartum endomyometritis, septic abortion. 

Guanethidine monosnlfate is a peripherally acting anti-adrenergic agent that interferes with release or distribntion of norepinephrine from nerve endings, resulting in reduction in total peripheral resistance and diastolic and systolic BP. It is indicated in the treatment of moderate and severe hypertension and renal hypertension, including that secondary to pyelonephritis, renal amyloidosis, and renal artery stenosis. 

Loracarbef, a synthetic beta lactam antibiotic of the car-bacephem class (200 to 400 mg p.o. q. 12 hours), is used in the treatment of secondary bacterial infections of acute bronchitis, acute bacterial exacerbations or chronic bronchitis, of pneumonia, pharyngitis, tonsillitis, sinusitis, acute otitis media, uncomplicated skin and skin-structure infections, impetigo, uncomplicated cystitis, and in uncomplicated pyelonephritis. 

Methenamine is an antiinfective agent. In acidic urine, methenamine is hydrolyzed to ammonia and formaldehyde, which is bactericidal to certain bacteria in urine. Acid salts (methenamine mandelate and hippurate) have some nonspecific bacteriostatic activity and help to maintain low nrine pH. It is indicated in suppression or elimination of bacterinria associated with pyelonephritis, cystitis, and other chronic UTls in treatment of infected residual urine, sometimes accompanying nenrologic disease or diabetes. 

Nitrofurantoin is approved only for the treatment of urinary tract infections caused by microorganisms known to be susceptible to the drug. Nitrofurantoin is not recommended for treatment of pyelonephritis or prostatitis but is effective for prophylaxis of recurrent urinary tract infections. 

In an acute uncomplicated pyelonephritis, a 7-day course of oral fluoroquinolones (eg, ciprofloxacin) is a primary choice. Backup drugs, which may require a 14-day course of treatment, include amoxicillin-clavulanate, an oral cephalosporin (eg, cephalexin), or TMP-SMZ. 

Primary antibiotics used in hospitalized patients with acute pyelonephritis include intravenous fluoroquinolone, or ampicillin plus gentamicin, or a third-generation cephalosporin. Treatment is usually for 14 days. 

Items 4-5 A 27-year-old pregnant patient with a past history of pyelonephritis has developed a severe upper respiratory tract infection that appears to be due to a bacterial pathogen. The woman is hospitalized and an antibacterial agent is to be selected for treatment. 

In another case, an elderly man treated with quinapril 20 mg daily for essential hypertension was found to have hyperkalaemia (serum potassium 7 to 7.4 mmol/L) and azotaemia after 20 days of treatment with co-tri-moxazole for mild acute pyelonephritis. Co-trimoxazole and quinapril were stopped, and nifedipine was given to control blood pressure. After treatment with dextrose, insulin, sodium polystyrene sulfonate and calcium gluconate, the azotaemia and hyperkalaemia resolved over 36 hours. ... 

Sulfonamides - The synergistic combination of sulfamethoxazole with trimethoprim has emerged as a first choice drug in the treatment of sal-monenosis , chronic pyelonephritis , non-specific and chronic urinary tract infections , and upper respiratory tract infections, especially chronic bronchitis . Favorable results were also achieved in the treatment of purulent angina, bacterial skin infections , staphylococcal osteomyelitis , and endocarditis due to E. coli as well as a variety... 

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