Editing Urinary Tract Infections (section)

===== Management =====
* '''Any substantial obstruction must be relieved expediently by the safest and simplest means.'''
**An obstructed kidney has difficulty concentrating and excreting antimicrobial agents.
*'''Antibiotics'''
**'''Oral'''
***'''Options[https://www.nice.org.uk/guidance/ng111/documents/draft-guideline-2 §]'''
****Amoxicillin / Clavulanic acid 625mg PO TID x 7 days
*****If a gram-positive organism is suspected, amoxicillin or amoxicillin/clavulanic acid is recommended
****Ciprofloxacin 500mg PO BID x 7 days
****Levofloxacin 500mg PO daily x 7 days
***Many physicians administer a single parenteral dose of an antimicrobial agent (ceftriaxone, gentamicin, or a fluoroquinolone) before initiating oral therapy.
**'''IV'''
***'''Options§'''
****Ceftriaxone 1-2g IV q24h
****Ciprofloxacin 400mg IV TID
****Gentamicin 5-7mg/kg q24h
*** For patients sufficiently ill to require hospitalization (high fever, high WBC count, vomiting, dehydration, evidence of sepsis), has complicated pyelonephritis, or fails to improve during the initial outpatient treatment period
*** If gram-positive cocci are causative, ampicillin/sulbactam with or without an aminoglycoside is recommended.
*'''Follow-up'''
**'''Repeat urine cultures should be performed after 5-7 days of therapy and 10-14 days after discontinuing antimicrobial therapy to ensure that the urinary tract remains free of infections.'''
***10-30% of individuals with acute pyelonephritis relapse after a 14-day course of therapy.
***Patients who relapse usually are cured by a second 14-day course of therapy, but occasionally a 6-week course is necessary