Related article: FDA Warnings for Fluoroquinolones.
A) Fluoroquinolone is the first-line treatment for mild and moderate pyelonephritis [If local rates of E. coli fluoroquinolone resistance are low (< 10%)]:
- Ciprofloxacin 500 mg PO twice daily x 7 d
- Ciprofloxacin extended-release 1000 mg PO x 7 d
- Levofloxacin 750 mg orally x 5-7 d
B) If fluoroquinolone resistance is >10%, start with an initial dose of a parenteral agent. Then complete treatment as guided by antimicrobial sensitivity results.
If the community fluoroquinolone resistance rate exceeds 10%, a one-time dose of a parenteral antimicrobial such as ceftriaxone or a consolidated dose of an aminoglycoside should be given, followed by an oral fluoroquinolone regimen.
- Ceftriaxone 1 gm IM or IV x 1
- Gentamicin 5 mg/kg IM or IV x 1
C) Modify initial treatment based upon results of urine culture and sensitivity.
- Oral beta-lactams are second-line agents due to high rates of relapse (even when the pathogen is susceptible).
Reference
Am Fam Physician. 2011 Sep 1;84(5):519-526. http://www.aafp.org/afp/2011/0901/p519.html
https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540458/all/Pyelonephritis__Acute__Uncomplicated