Table 2. Recommended empirical short-term antibiotic treatment of uncomplicated pyelonephritis in women in the premenopause (standard group) (listing in alphabetic order).
| Substance | Daily dose | Duration | Eradication rate in sensitive pathogens | Sensitivity |
Collateral damage |
Safety/adverse drug reactions (ADR) |
| Oral treatment in mild to moderate disease | ||||||
| Ciprofloxacin*1 | 500–750 mg 2 × daily | 7–10 days | +++ | ++ | + | ++ |
| Levofloxacin | 750 mg 1 × daily | 5 days | +++ | ++ | + | ++ |
| Cefpodoxime-proxetil | 200 mg 2 × daily | 10 days | +++ | ++ | + | +++ |
| Ceftibuten*2 | 400 mg 1 × daily | 10 days | +++ | ++ | + | +++ |
| Initial parenteral treatment in severe disease | ||||||
| Following improvement, in the presence of pathogen sensitivity oral sequential treatment with one of the above-mentioned oral agents can be initiated. The total duration of treatment is 1–2 weeks; therefore, no duration of treatment is given for the parenteral antibiotics. | ||||||
| First-choice drugs | ||||||
| Ciprofloxacin | 400 mg (2)–3 × daily | +++ | ++ | + | ++ | |
| Levofloxacin | 750 mg 1 × daily | +++ | ++ | + | ++ | |
| Ceftriaxone*1, *3 | (1)–2 g 1 × daily | +++ | ++ | + | +++ | |
| Cefotaxime*4 | 2 g 3 × daily | +++ | ++ | + | +++ | |
| Second-choice drugs | ||||||
| Amoxicillin/ clavulanic acid*4, *5 | 2.2 g 3 × daily | ++ | + | +++ | +++ | |
| Amikacin | 15 mg/kg 1 × daily | ++ | ++ | ++ | +(+) | |
| Gentamicin | 5 mg/kg 1 × daily | ++ | ++ | ++ | +(+) | |
| Cefepime*1, *3 | (1)–2 g 2 × daily | +++ | ++ | + | +++ | |
| Ceftazidime*4 | (1)–2 g 3 × daily | +++ | ++ | + | +++ | |
| Ceftazidime/avibactam | 2.5 g 3 × daily | +++ | +++ | ++ | +++ | |
| Ceftolozane/tazobactam | 1.5 g 3 × daily | +++ | +++ | ++ | +++ | |
| Piperacillin/ tazobactam*1, *3 | 4.5 g 3 × daily | +++ | +++ | ++ | +++ | |
| Ertapenem*3, *6 | 1 g 1 × daily | +++ | +++ | ++ | +++ | |
| Imipenem/cilastatin*1, *3, *6 | 1 g/1g 3 × daily | +++ | +++ | ++ | +++ | |
| Meropenem*3, *6, *7 | 1 g 3 × daily | +++ | +++ | ++ | +++ | |
*1 Low dosage investigated, high dosage recommended by experts; *2 no longer on sale in Germany; *3 same protocol for acute uncomplicated pyelonephritis and complicated urinary tract infection (stratification not always possible); *4 not investigated as sole substance in acute uncomplicated pyelonephritis; *5 principally for Gram-positive pathogens;
*6 only in extended-spectrum betalactamase resistance >10%; *7 only high dosages investigated; symbols as explained in Table 1