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]
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Escherichia coli
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Staphylococcus saprophyticus
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Staphylococcus aureus
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Proteus species (spp)
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Klebsiella spp
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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:
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Ciprofloxacin 500 mg q12hr or
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Ciprofloxacin Extended Release 1000 mg PO daily or
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Levofloxacin 750 mg PO daily or
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Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12hr or
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Cefuroxime 750 mg PO q8hr or
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Cefixime 400 mg PO daily or
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Cefpodoxime 200 mg PO q12hr
Intravenous options include the following:
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Ceftriaxone 1g IV q24hr or
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Ciprofloxacin 400 mg IV q12hr or
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Levofloxacin 750 mg IV q24hr or
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Piperacillin/tazobactam 3.375-4.5 g IV q6hr or
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Meropenem 1 g IV q8hr or
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Ertapenem 1 g IV q24hr
S saprophyticus
Oral options include the following:
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Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12hr or
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Amoxicillin/clavulanate (875 mg/125 mg) 1 tablet PO q12hr
The intravenous option is as follows:
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Ampicillin/sulbactam 3 g IV q6hr
S aureus
Oral options include the following:
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Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12hr or
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Amoxicillin/clavulanate (875 mg/125 mg) 1 tablet PO q12hr
The intravenous option is as follows:
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Ampicillin/sulbactam 3 g IV Q6H
Proteus spp
Oral options include the following:
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Ciprofloxacin 500 mg PO q12hr or
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Levofloxacin 750 mg PO daily or
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Trimethoprim-sulfamethoxazole (160 mg/800 mg) 1 DS tablet PO q12hr
Intravenous options include the following:
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Ceftriaxone 1g IV q24hr or
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Ciprofloxacin 400 mg IV q12hr or
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Levofloxacin 750 mg IV q24hr or
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Piperacillin/tazobactam 3.375-4.5 g q6hr or
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Meropenem 1 g IV q8hr or
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Ertapenem 1 g IV q24hr
Klebsiella spp
Oral options include the following:
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Ciprofloxacin 500 mg PO q12hr or
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Levofloxacin 750 mg PO daily
Intravenous options include the following:
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Ciprofloxacin 400 mg IV q12hr or
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Levofloxacin 750 mg IV q24hr or
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Ceftriaxone 1 g IV q24hr or
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Cefepime 1-2 g IV q8-12hr or
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Imipenem 500 mg IV q6hr or
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Ertapenem 1 g IV q24hr or
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Meropenem 1 g IV q8hr
Enterococcus spp
Oral options include the following:
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Amoxicillin 500 mg PO q8hr or
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Amoxicillin/clavulanate 875/125 mg BID or
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Cefixime 400 mg PO daily or
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Cefpodoxime 200 mg PO BID
Intravenous options include the following:
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Ampicillin 2 g IV q4hr or
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Piperacillin/Tazobactam 3.375-4.5 g q6hr or
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Ceftriaxone 1g IV q24hr or
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Cefepime 1-2 g IV q8-12hr or
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Ceftolozane-tazobactam 1.5g IV q8hr or
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Ceftazidime-avibactam 2.5 g IV q8hr or
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Meropenem 1 g IV q8hr or
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Gentamicin 5.0-7.5 mg/kg body weight IV q24hr