Active substances: Norfloxacin
The suprapubic discomfort or dysuria common to UTI can be treated with oral analgesics i. A retrospective comparison of inpatient and outpatient management of pyelonephritis suggested that general guidelines for admission should include the following: 1 underlying anatomical urinary tract abnormality; 2 an immunocompromised host i.
Because multi-drug resistance is common in VRE isolates, susceptibility testing is recommended for ampicillin, aminoglycosides, chloramphenicol, fluoroquinolones, minocycline a tetracycline, and rifampin.
Patients with pyelonephritis generally are more ill than those with uncomplicated cystitis. As would be expected for a more invasive infection, the recommended treatment duration is significantly longer. However, there are few data demonstrating superiority of intravenous over oral antibiotics.
Even for patients who will be managed as outpatients, many physicians will give at least one dose of IV antibiotic, followed by oral therapy for the duration of the treatment course.
To evaluate the efficacy and cost of antibiotics used in pyelonephritis, a randomized, double-blind, multicenter trial analyzed 255 women with acute uncomplicated pyelonephritis. Health care resource use and estimated total treatment costs were calculated, from initial evaluation to prescription pad to cure, including needed hospitalization, lab testing, office visits, and other procedures.
These studies help confirm that knowledge of local resistance rates is imperative in deciding which antibiotics should be used in the treatment of UTI.
They support the use of ciprofloxacin as a first-line agent in the management of uncomplicated pyelonephritis. With the current outcome- and cost-sensitive environment of managed care, clinicians must make informed choices in the management of their patients.
In pregnant women, pyelonephritis tends to occur more commonly during the second half of pregnancy. Inpatient treatment with intravenous antibiotics and close monitoring usually are required to maximize outcomes.
Treatment options are similar to other adult regimens, including ampicillin with gentamicin, cephalosporins, and extended spectrum penicillins or aztreonam.