Spectrum: Local Antimicrobial Stewardship, for Eastern Health

Pyelonephritis and Urosepsis Duration of Therapy

Recommended Duration

7 days

β-lactam antibiotics generally require longer treatment courses compared to other drugs and have higher failure rates even when organism susceptibility is confirmed. If using these agents recommended minimum duration usually 10 days

Male Pyelonephritis Therapy

Female Pyelonephritis Therapy

Shortest Duration

Minimum duration studied without evidence of reduced efficacy

5 days

β-lactam antibiotics generally require longer treatment courses compared to other drugs and have higher failure rates even when organism susceptibility is confirmed. If using these agents recommended minimum duration usually 10 days.

Switch to PO

Consider transition to PO antimicrobial on Day 3 of therapy if patient is improving clinically, can absorb oral intake, and there is an appropriate oral drug for identified organism(s).

Drugs with High Oral Bioavailability

Excluded Patients

Complicated urinary pathology (e.g. stents)

Additional Notes

  • Despite relatively strong data, the use of 7 days for pyelonephritis is less commonly accepted and has not been included in many guidelines

  • There is a lack of data for duration in complicated cystitis,

and in special populations such as the immunocompromised and those with structurally abnormal urinary tracts

  • Adapted from AMMI Canada Position Statement on the Appropriate Duration of Antimicrobial Therapy (2018)

More Information

References
  1. Sandberg, Skoog, Bornefalk et al., Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomized, open label and double-blind, placebo-controlled, non-inferiority trial. The Lancet. 380(aug 4):484-490. 2012
  2. Kyriakidou, Rafailidis, Matthaiou et al., Short- versus long-course antibiotic therapy for acute pyelonephritis in adolescents and adults: A meta-analysis of randomized controlled trials. Clinical Therapeutics. 30(10):1859-1868. 2008
  3. Drekonja, Rector, Cutting et al., Urinary tract infection in male veterans. JAMA Internal Medicine. 173(1):62-68. 2013
  4. Eliakim-Raz, Yahav, Paul, Leibovici, Duration of antibiotic treatment for acute pyelonephritis and septic urinary tract infection – 7 days or less versus longer treatment: systematic review and meta-analysis of randomized controlled trials. Journal of Antimicrobial Chemotherapy. 68(10):2183-91. 2013
  5. Talan, Stamm Hooton et al., Comparison of ciprofloxacin (7days) and trimethoprimsulfamethoxazole (14 days) for acute uncomplicated pyelonephritis in women. JAMA. 283(12):1583-90. 2000