Oral antibiotic regimens for acute pyelonephritis in nonpregnant adults

For the treatment of pyelonephritis in pregnancy, see Acute pyelonephritis in pregnancy.

See Approach to empirical antibiotic choice for UTI in adults and Rationale for oral antibiotic therapy for acute pyelonephritis in nonpregnant adults for a discussion of antibiotic choice.

For empirical oral antibiotic therapy for pyelonephritis in nonpregnant adults, while awaiting the results of investigations, useHeil, 2021McAteer, 2023Mponponsuo, 2023:

For nonpregnant adults with hypersensitivity to penicillin, use:

Modify empirical therapy based on the results of culture and susceptibility testing. If the pathogen is susceptible to one of the following regimens, stop amoxicillin+clavulanate or ciprofloxacin and use the narrowest spectrum antibiotic to which the pathogen is susceptibleDiaz-Brochero, 2022Heil, 2021McAteer, 2023Mponponsuo, 2023National Institute for Health and Care Excellence (NICE), October 2018:

If resistance to all of the above drugs is confirmed and the pathogen is shown to be ciprofloxacin susceptible, use:

Fever may take 48 to 72 hours to resolve in pyelonephritis, but patients often report feeling systemically better before then. If the patient is not improving clinically, consider if the patient is at risk of a UTI caused by multidrug-resistant gram-negative bacteria, and reconsider the diagnosis of pyelonephritis.

For patients with ongoing pyelonephritis symptoms following appropriate antibiotic therapy, seek expert urology advice.

Do not perform post-treatment urine culture to confirm resolution of infection for asymptomatic patients, except for pregnant patients and those with acute bacterial prostatitis.