Pediatric Pyelonephritis Medication

Updated: Apr 25, 2022
  • Author: Patrick B Hinfey, MD; Chief Editor: Russell W Steele, MD  more...
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Medication Summary

As previously stated, most cases of pyelonephritis respond readily to antibiotic treatment without further sequelae. Antibiotic therapy should be started after the urinalysis and culture have been performed, with the results of urine culture ultimately dictating the choice of antibiotics. [28] A 7- to 14-day course of antibiotics is recommended. Special attention is needed when dosing antibiotics in neonates and in infants born prematurely.


Antibiotic Agents

Class Summary

Empiric antibiotics should be chosen to cover E coli and Enterococcus, Proteus, and Klebsiella species.

Cefixime (Suprax)

Cefixime is a third-generation cephalosporin with broad, gram-negative activity. The drug arrests cell-wall development. Tablets are no longer available in United States; a suspension is available from Lupin Pharmaceutical.


This is an aminoglycoside antibiotic for gram-negative coverage. Gentamicin is administered parenterally and may be coadministered with ampicillin.

Ceftriaxone (Rocephin)

Ceftriaxone is a third-generation cephalosporin with broad-spectrum, gram-negative activity; it has decreased efficacy against gram-positive organisms. Ceftriaxone arrests bacterial growth by binding to 1 or more penicillin-binding proteins.

Cefotaxime (Claforan)

Cefotaxime is a third-generation cephalosporin with a gram-negative spectrum; it has decreased efficacy against gram-positive organisms. Cefotaxime arrests bacterial cell ̶ wall synthesis.

TMP-SMZ (BactrimDS, Septra DS)

TMP-SMZ inhibits bacterial growth by inhibiting the synthesis of dihydrofolic acid. It exerts antibacterial activity against common urinary tract pathogens.

Amoxicillin and clavulanic acid (Augmentin, Amoclan)

This is an amino penicillin with a beta-lactamase inhibitor. It is for infants and children over age 3 months, base dosing on amoxicillin content. Because of different amoxicillin–clavulanic acid ratios in the 250-mg (250 mg/125 mg) versus 250-mg chewable tablet (250 mg/62.5 mg), do not use the 250-mg tablet until the child weighs more than 40 kg.

Amoxicillin (Moxatag)

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


Ampicillin has bactericidal activity against susceptible organisms. It is administered parenterally and is used in combination with gentamicin or cefotaxime. Ampicillin is an alternative to amoxicillin when patients are unable to take medication orally.

Ciprofloxacin (Cipro, Proquin)

Ciprofloxacin is a fluoroquinolone that inhibits bacterial deoxyribonucleic acid (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. Ciprofloxacin has no activity against anaerobes. Continue treatment for at least 2 days (7-14 d typical) after signs and symptoms have disappeared.

Ceftolozane/tazobactam (Zerbaxa)

Indicated for children aged birth and older with complicated urinary tract infections (cUTI), including pyelonephritis, caused by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa.