Pyelonephritis Organism-Specific Therapy 

Updated: Aug 18, 2020
  • Author: Amy A Yau, MD; Chief Editor: Thomas E Herchline, MD  more...
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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:

Intravenous options include the following:

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:

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