Acute Pyelonephritis
E. coli
Cephalexin 100mg/kg/day PO div q8h (max 1000mg/dose)
OR, if IV administration is desired:
Ceftriaxone 50mg/kg/day IV div q24h (max 1000mg/dose)¹
IV therapy should be considered for:
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Patients <2 months of age (see febrile neonate section)
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Patients with concern for severe systemic illness (e.g. urosepsis with toxic appearance, prolonged capillary refill, or hypotension)
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Inability to tolerate oral medication secondary to vomiting
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Failure to respond to prior PO therapy
Empiric Therapy & Alternative Regimens
Duration of Therapy & Clinical Pearls
If patient has history of prior urinary tract infections, target empiric therapy based on past susceptibilities.
Consider diagnosis of pyelonephritis in patients with fever, flank pain, or ill appearance in those patients with dysuria and laboratory findings consistent with UTI.
IV to PO Transition: Tailor to sensitivity of causative organism with choice of narrower (e.g. amoxicillin, TMP/SMX) rather than broader spectrum (2nd or 3rd generation cephalosporin) as able.¹
Length of Therapy (PO/IV + PO):
7 days³