Empirical therapy for acute pyelonephritis in pregnancy
For the treatment of patients with sepsis or septic shock, see Sepsis and septic shock from a urinary tract source in adults.
See Rationale for empirical therapy for acute pyelonephritis in pregnancy for a discussion of antibiotic choice.
For the empirical therapy for pyelonephritis in pregnancy, while awaiting the results of investigations, use:
1gentamicin intravenously; see Gentamicin initial dose calculator for adults for initial dose. See Principles of aminoglycoside use for prescribing considerations and subsequent dosing. See advice on modification and duration of therapy gentamicin gentamicin gentamicin
OR
PLUS with either of the above regimens
1amoxicillin 2 g intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see amoxicillin dosage adjustment. See advice on modification and duration of therapy amoxicillin amoxicillin amoxicillin
OR
1ampicillin 2 g intravenously, 6-hourly. For dosage adjustment in adults with kidney impairment, see ampicillin dosage adjustment. See advice on modification and duration of therapy ampicillin ampicillin ampicillin
OR as a single drug
1ceftriaxone 1 g intravenously, daily. See advice on modification and duration of therapy. ceftriaxone ceftriaxone ceftriaxone
Ceftriaxone monotherapy (as above) may be preferred for patients in whom intravenous therapy is likely to continue for 72 hours or longer1, to avoid the need to switch to a non–aminoglycoside-containing regimen at 72 hours. Ceftriaxone is also recommended if the patient has contraindications or precautions that preclude aminoglycoside use.
For pregnant patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use ceftriaxone (as above).
For pregnant patients who have had a severe immediate2 hypersensitivity reaction to a penicillin, ceftriaxone (as above) can be considered (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).
For pregnant patients who have had a severe immediate2 hypersensitivity reaction to a penicillin in whom ceftriaxone is not used, or for pregnant patients who have had a severe delayed3 hypersensitivity reaction to a penicillin, use gentamicin or tobramycin as a single drug and seek expert advice for additional antibiotics to ensure activity against Streptococcus agalactiae (group B streptococcus [GBS]).