Chronic Pyelonephritis Medication

Updated: Jun 19, 2023
  • Author: James W Lohr, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Medication Summary

The penicillins (amoxicillin) and first-generation cephalosporins are the drugs of choice for chronic pyelonephritis because of good activity against gram-negative rods and good oral bioavailability. In infants, the choice of antibiotics is either amoxicillin or a first-generation cephalosporin. In patients aged 3-6 months, therapy can be changed to sulfamethoxazole or nitrofurantoin. Older children and adults may be treated with trimethoprim-sulfamethoxazole (Bactrim).

Once one antibiotic is chosen, frequent changes in the antibiotic regimen are discouraged, to help prevent the development of resistance.



Class Summary

Antibiotic therapy must be comprehensive and cover all likely pathogens in the context of this clinical setting.

Amoxicillin (Moxatag)

Amoxicillin interferes with the synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria..

Cephalexin (Keflex)

Cephalexin is a first-generation cephalosporin that arrests bacterial growth by inhibiting bacterial cell wall synthesis. It has bactericidal activity against rapidly growing organisms.

Trimethoprim/sulfamethoxazole (Bactrim DS, Septra DS, Sulfatrim)

Trimethoprim/sulfamethoxazole inhibits bacterial growth by inhibiting the synthesis of dihydrofolic acid. Bacterial species it acts against include common urinary tract pathogens, except Pseudomonas aeruginosa.

Nitrofurantoin (Furadantin, Macrodantin, Macrobid)

This is a synthetic nitrofuran that interferes with bacterial carbohydrate metabolism by inhibiting acetylcoenzyme A. Nitrofurantoin is bacteriostatic at low concentrations (5-10 mcg/mL) and bactericidal at higher concentrations.