Empiric treatment regimens

1. Nitrofurantoin (Macrodantin) 100 mg BID

2. Cephalexin (Keflex) 500 mg BID to QID

C. Each of these drugs is given for three to seven days.

D. Other regimens which have a broader spectrum of activity include amoxicillin-clavulanate (Augmentin) 500 mg BID or 250 mg TID, trimethoprim-sulfamethoxazole (Bactrim) 1 DS BID but not in the third trimester of pregnancy, cefpodoxime proxetil (Vantin) 100 mg BID, and cefixime (Suprax) 400 mg qD. All of these drugs can be used for three to seven days. Fluoroquinolones should be avoided in pregnancy.

E. Monthly urine cultures should be performed beginning one to two weeks after completion of treatment.

V. Pyelonephritis complicates 1 to 2 percent of all pregnancies. Risk factors include asymptomatic bacteriuria, previous pyelonephritis, renal and collecting system anomalies, and renal calculi.

A. Presentation consists of fever, chills, and costovertebral angle tenderness. Other symptoms include dysuria, nausea, vomiting, and respiratory distress.

B. Urinalysis reveals one or two bacteria per highpower field in an unspun catheterized specimen or 20 bacteria per HPF in a spun specimen; white cell casts confirm the diagnosis. Urine culture and antimicrobial susceptibility testing should be performed.

C. Blood cultures are positive in 10 to 20 percent of patients.

D. Outpatient treatment, with one of the above regimens, may be considered in the absence of underlying medical conditions, anatomic abnormalities, pregnancy complications, or signs of sepsis.

0 0

Post a comment