Urinary Tract Infection - Medications

Antibiotics for Kidney Infections (Pyelonephritis)

Treating Uncomplicated Kidney Infections. Patients with uncomplicated kidney infections (pyelonephritis) may be treated at home with oral antibiotics. Such patients are healthy and non pregnant. They typically are experiencing fever, chills, and flank pain. However, they are not nauseous or vomiting and show no symptoms or signs of kidney involvement or complicated infection.

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The standard treatment for uncomplicated pyelonephritis is a 14-day course of oral antibiotics, usually trimethoprim-sulfamethoxazole (TMP-SMX) or a fluoroquinolone. Sometimes patients with uncomplicated pyelonephritis are first given an antibiotic injection, if indicated.

Oral amoxicillin or amoxicillin-clavulanate (Augmentin) may be prescribed for women with bacteria that do not respond to standard regimens (e.g., gram-positive organisms, including Enterococcus species and S. saprophyticus).

A urine culture is may be obtained within one week of completion of therapy and again four weeks later.

Treating Moderate to Severe Kidney Infections. Patients with moderate to severe acute kidney infection and those with severe symptoms or other complications may need to be hospitalized. In such cases, antibiotics (ceftriaxone and gentamicin) are usually given intravenously for three to five days or until symptoms are relieved and patients have not shown any signs of fever for 24 to 48 hours. One study reported that oral cefixime may be as effective as intravenous antibiotics in small children with UTIs and fever. In any case, adult patients are switched to oral antibiotic therapy after symptoms have subsided and continued for another two weeks; treatment for longer than this has no additional benefit.

If fever and back pain persist after 72 hours of antibiotic administration, the doctor will usually order imaging tests to see if abscesses, obstructions, or other abnormalities are present.

Treating Chronic Kidney Infections. Patients with chronic pyelonephritis are often treated with long-term antibiotics, even during periods when they have no symptoms.

Treatments for Interstitial Cystitis

There are two approved treatments for interstitial cystitis: Pentosan polysulfate (Elmiron), and dimethyl sulfoxide (DMSO). Patients generally prefer Elmiron because it can be taken by mouth. A DMSO solution is instilled into the bladder through a catheter. Elmiron is a type of blood thinner that helps to coat the bladder lining and prevent infections. It may take several months before it has an effect on symptoms, but its benefits increase the longer it is used.