Renal Corticomedullary Abscess Medication

  • Author: Aaron Benson, MD; Chief Editor: Edward David Kim, MD, FACS   more...
 
Updated: Nov 21, 2011
 

Medication Summary

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications.

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Antibiotics

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

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Piperacillin and tazobactam sodium (Zosyn)

 

Antipseudomonal penicillin plus beta-lactamase inhibitor. Inhibits biosynthesis of cell wall mucopeptide and is effective during active multiplication stage.

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Ticarcillin and clavulanate (Timentin)

 

Inhibits biosynthesis of cell wall mucopeptide and is effective during stage of active growth. Antipseudomonal penicillin plus beta-lactamase inhibitor that provides coverage against most gram-positive organisms, most gram-negative organisms, and most anaerobes.

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Nafcillin (Nafcil, Nallpen, Unipen)

 

Initial therapy for suspected penicillin G–resistant streptococcal or staphylococcal infections.

Use parenteral therapy initially in severe infections. Change to PO therapy as condition warrants.

Because of thrombophlebitis, particularly in the elderly, administer parenterally only for short term (1-2 d); change to PO route as clinically indicated.

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Ceftazidime (Fortaz)

 

Third-generation cephalosporin with broad-spectrum, gram-negative activity, including Pseudomonas species; lower efficacy against gram-positive organisms; higher efficacy against resistant organisms. Arrests bacterial growth by binding to one or more penicillin-binding proteins, which, in turn, inhibit the final transpeptidation step of peptidoglycan synthesis in bacterial cell wall synthesis, thus inhibiting cell wall biosynthesis. The condition of the patient, severity of the infection, and susceptibility of the microorganism should determine the proper dose and route of administration.

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Cefepime (Maxipime)

 

Fourth-generation cephalosporin. Gram-negative coverage comparable to that of ceftazidime but has better gram-positive coverage (comparable to ceftriaxone). Cefepime is a zwitter ion; rapidly penetrates gram-negative cells. Best beta-lactam drug for IM administration. Poor capacity to cross blood-brain barrier precludes use for treatment of meningitis.

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Ciprofloxacin (Cipro)

 

Fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Has no activity against anaerobes. Continue treatment for at least 2 d (7-14 d typical) after signs and symptoms have disappeared.

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Levofloxacin (Levaquin)

 

For pseudomonal infections and infections due to multidrug-resistant gram-negative organisms.

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Gentamicin (Garamycin)

 

Aminoglycoside antibiotic for gram-negative coverage bacteria, including Pseudomonas species. Synergistic drug with beta-lactamase against enterococci. Interferes with bacterial protein synthesis by binding to 30S and 50S ribosomal subunits.

Dosing regimens are numerous and are adjusted based on CrCl and changes in volume of distribution, as well as body space into which agent needs to distribute. Dose of gentamicin may be given IV/IM. Each regimen must be followed by at least trough level drawn on third or fourth dose, 0.5 h before dosing; may draw peak level 0.5 h after 30-min infusion.

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Amikacin (Amikin)

 

Irreversibly binds to 30S subunit of bacterial ribosomes; blocks recognition step in protein synthesis; causes growth inhibition. For gram-negative bacterial coverage of infections resistant to gentamicin and tobramycin. Effective against Pseudomonas aeruginosa.

Use patient's IBW for dosage calculation. The same principles of drug monitoring for gentamicin apply to amikacin.

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Tobramycin (Nebcin)

 

Aminoglycoside antibiotic for gram-negative coverage. Used in combination with both an agent against gram-positive organisms and one that covers anaerobes.

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Contributor Information and Disclosures
Author

Aaron Benson, MD  Staff Physician, Department of Surgery, Division of Urology, Southern Illinois University School of Medicine

Aaron Benson, MD is a member of the following medical societies: American Medical Association, American Urological Association, and Illinois State Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Thomas H Tarter, MD, PhD  Associate Professor, Department of Surgery, Division of Urology, Director of Urologic Oncology, Simmons Cooper Cancer Institute, Southern Illinois University School of Medicine

Thomas H Tarter, MD, PhD is a member of the following medical societies: American College of Surgeons Oncology Group, American Medical Association, American Urological Association, and Society of Urologic Oncology

Disclosure: Illinois Cryotherapy Enterprise Ownership interest Other

Julius Lynn Teague, MD, FACS, FAAP  Medical Director, Pediatric Urology, Greenville Hospital System Children's Hospital

Julius Lynn Teague, MD, FACS, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Urological Association, and Christian Medical & Dental Society

Disclosure: Nothing to disclose.

Keith Steinbecker, MD  Consulting Staff, Department of Urology, St John's Mercy Medical Center

Keith Steinbecker, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

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: Medscape Salary Employment

Shlomo Raz, MD  Professor, Department of Surgery, Division of Urology, University of California at Los Angeles School of Medicine

Shlomo Raz, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, and California Medical Association

Disclosure: Nothing to disclose.

J Stuart Wolf Jr, MD, FACS  The David A Bloom Professor of Urology, Director, Division of Endourology and Stone Disease, Department of Urology, University of Michigan Medical School

J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS  Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Sexual Medicine Society of North America, and Tennessee Medical Association

Disclosure: Lilly Consulting fee Advisor; Astellas Consulting fee Speaking and teaching; Watson Consulting fee Speaking and teaching; Allergan Consulting fee Speaking and teaching

References

  1. Baradkar VP, Mathur M, Kumar S. Renal abscess due to Escherichia coli in a child. Saudi J Kidney Dis Transpl. Nov 2011;22(6):1215-8. [Medline].

  2. Huisman TK, Sands JP. Focal xanthogranulomatous pyelonephritis associated with renal cell carcinoma. Urology. Mar 1992;39(3):281-4. [Medline].

  3. Velciov S, Gluhovschi G, Trandafirescu V, Petrica L, Bozdog G, Gluhovschi C, et al. Specifics of the renal abscess in nephrology: observations of a clinic from a county hospital in Western Romania. Rom J Intern Med. 2011;49(1):59-66. [Medline].

  4. Vourganti S, Agarwal PK, Bodner DR, et al. Ultrasonographic evaluation of renal infections. Radiol Clin N Am. November 2006;44:763-75. [Medline].

  5. Fontanilla T, Minaya J, Cortés C, Hernando CG, Arangüena RP, Arriaga J, et al. Acute complicated pyelonephritis: contrast-enhanced ultrasound. Abdom Imaging. Jul 27 2011;[Medline].

  6. Claes H, Vereecken R, Oyen R, et al. Xanthogranulomatous pyelonephritis with emphasis on computerized tomography scan. Retrospective study of 20 cases and literature review. Urology. Apr 1987;29(4):389-93. [Medline].

  7. Dalla Palma L, Pozzi-Mucelli F, Ene V. Medical treatment of renal and perirenal abscesses: CT evaluation. Clin Radiol. Dec 1999;54(12):792-7. [Medline].

  8. Kawashima A, Sandler CM, Ernst RD, et al. Renal inflammatory disease: the current role of CT. Crit Rev Diagn Imaging. Oct 1997;38(5):369-415. [Medline].

  9. Abdul-Halim H, Kehinde EO, Abdeen S, et al. Severe emphysematous pyelonephritis in diabetic patients: diagnosis and aspects of surgical management. Urol Int. 2005;75(2):123-8. [Medline].

  10. Alan C, Ataus S, Tunç B. Xanthogranulamatous pyelonephritis with psoas abscess: 2 cases and review of the literature. Int Urol Nephrol. 2004;36(4):489-93. [Medline].

  11. Anderson KA, McAninch JW. Renal abscesses: classification and review of 40 cases. Urology. Oct 1980;16(4):333-8. [Medline].

  12. Brook I. Urinary tract and genito-urinary suppurative infections due to anaerobic bacteria. Int J Urol. Mar 2004;11(3):133-41. [Medline].

  13. Chen J, Koontz WW. Inflammatory lesions of the kidney. AUA Update Series. 1995;XIV(26):210-216.

  14. [Best Evidence] Cheng CH, Tsau YK, Lin TY. Effective duration of antimicrobial therapy for the treatment of acute lobar nephronia. Pediatrics. Jan 2006;117(1):e84-9. [Medline].

  15. Coelho RF, Schneider-Monteiro ED, Mesquita JL, et al. Renal and perinephric abscesses: analysis of 65 consecutive cases. World J Surg. February 2007;31:431-6. [Medline].

  16. Corriere JN Jr, Sandler CM. The diagnosis and immediate therapy of acute renal and perirenal infections. Urol Clin North Am. Jun 1982;9(2):219-28. [Medline].

  17. Dembry LM. Renal and perirenal abscesses. Curr Treat Options Infect Dis. 2002;4:21-30.

  18. Dembry LM, Andriole VT. Renal and perirenal abscesses. Infect Dis Clin North Am. Sep 1997;11(3):663-80. [Medline].

  19. Demertzis J, Menias CO. State of the art: imaging of renal infections. Emerg Radiol. Apr 2007;14(1):13-22. [Medline].

  20. Forland M, Thomas V, Shelokov A. Urinary tract infections in patients with diabetes mellitus. Studies on antibody coating of bacteria. JAMA. Oct 31 1977;238(18):1924-6. [Medline].

  21. Geeting GK, Shaikh N. Renal abscess. J Emerg Med. Jul 2006;31(1):99-100. [Medline].

  22. Malek RS, Elder JS. Xanthogranulomatous pyelonephritis: a critical analysis of 26 cases and of the literature. J Urol. May 1978;119(5):589-93. [Medline].

  23. Meares EM. Nonspecific infections of the genitourinary tract. In: Tanagho EA, McAnich JW, eds. Smith's General Urology. New York, NY: McGraw-Hill; 1995:201-44.

  24. Medical Economics Company. Physician's Desk Reference. 54th ed. 2000.

  25. Olazabal A, Velasco M, Martinez A, et al. Emphysematous pyelonephritis. Urology. Jan 1987;29(1):95-8. [Medline].

  26. Patel NP, Lavengood RW, Fernandes M, et al. Gas-forming infections in genitourinary tract. Urology. Apr 1992;39(4):341-5. [Medline].

  27. Patterson JE, Andriole VT. Bacterial urinary tract infections in diabetes. Infect Dis Clin North Am. Sep 1997;11(3):735-50. [Medline].

  28. Petronic V, Buturovic J, Isvaneski M. Xanthogranulomatous pyelonephritis. Br J Urol. Oct 1989;64(4):336-8. [Medline].

  29. Rinder MR. Renal abscess: an illustrative case and review of the literature. Md Med J. Oct 1996;45(10):839-43. [Medline].

  30. Roberts JA. Management of pyelonephritis and upper urinary tract infections. Urol Clin North Am. Nov 1999;26(4):753-63. [Medline].

  31. Roberts JA. Pyelonephritis, cortical abscess, and perinephric abscess. Urol Clin North Am. Nov 1986;13(4):637-45. [Medline].

  32. Rubenstein JN, Schaeffer AJ. Managing complicated urinary tract infections: the urologic view. Infect Dis Clin North Am. Jun 2003;17(2):333-51. [Medline].

  33. Schaeffer AJ. Infections of the urinary tract. In: Campbell MF, Retik AB, eds. Campbell's Urology. 7th ed. Philadelphia, Pa: WB Saunders and Co; 1998:533-614.

  34. Secil M, Gulcu A, Goktay AY, et al. Renal corticomedullary abscess. J Emer Med. January 2007;32:119-21. [Medline].

  35. Seidel T, Kuwertz-Broking E, Kaczmarek S, et al. Acute focal bacterial nephritis in 25 children. Pediatr Nephrol. November 2007;22:1897-1901. [Medline].

  36. Stamm WE, Hooton TM, Johnson JR, et al. Urinary tract infections: from pathogenesis to treatment. J Infect Dis. Mar 1989;159(3):400-6. [Medline].

  37. Yen DH, Hu SC, Tsai J, et al. Renal abscess: early diagnosis and treatment. Am J Emerg Med. Mar 1999;17(2):192-7. [Medline].

 
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Contrasted CT scan that demonstrates a corticomedullary abscess in a 27-year-old patient with diabetes mellitus who has a history of multiple urinary tract infections. Note the heterogeneous hypodense lesion in the right kidney. Extracapsular extension is not present.
 
 
 
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