Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

Pyelonephritis

First Line

Ceftriaxone 1g IV q24h

PLUS*

Ampicillin 1g IV q6h

  • *If prior urine colonization with enterococcus or septic patients with suspected UTI

  • If beta-lactam allergy, use Vancomycin 15-20mg/kg IV Q12H instead of Ampicillin

Second Line

Gentamicin 1.5- 2 mg/kg IV q8h

  • Gentamicin should be avoided in those with impaired renal function.

  • Caution is advised regarding the risk of ototoxicity, especially with prolonged use of gentamicin.

  • If more than 24 hours of treatment with gentamicin is required, then pharmacist involvement is recommended.

PLUS*

Ampicillin 1g IV q6h

  • *If prior urine colonization with enterococcus or septic patients with suspected UTI

  • If beta-lactam allergy, use Vancomycin 15-20mg/kg IV Q12H instead of Ampicillin