Inpatient treatment

1. Fluoroquinolones should not be used because of adverse effects on growing cartilage. Parenteral beta lactams or gentamicin are the preferred antibiotics. Symptoms that persist for more than 48 hours, despite intravenous antibiotic therapy, require further evaluation with a renal ultrasound to assess for perinephric abscess or renal calculi.

2. Intravenous treatment should continue until the patient is afebrile for 48 hours. Inpatient therapy is followed by oral antibiotics to complete 10 to 14 days of treatment.

Parenteral Regimens for Empiric Treatment of Acute Pyelonephritis in Pregnancy

Antibiotic, dose


Ceftriaxone, 1 g

Q24 hours

Gentamicin, 1 mg/kg (+ ampicillin)

Q8 hours

Ampicillin, 1-2 g (plus gentamicin)*

Q6 hours

Ticarcillin-clavulanate (Timentin) 3.2 g

Q8 hours

Piperacillin-tazobactam 3.375 g*

Q8-12 hours

Imipenem-cilastatin, 250-500 mg

Q6-8 hours

* Recommended regimen if enterococcus suspected

3. Low-dose antimicrobial prophylaxis, such as nitrofurantoin (Macrodantin) 5o to 100 mg PO QHS or cephalexin (Keflex) 250 to 500 mg PO QHS, and periodic urinary surveillance for infection are recommended for the remainder of the pregnancy.

References: See page 184.

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