Recurrent Pyelonephritis in Quadriplegia: Rethinking Oral Cefdinir in the Presence of Nephrolithiasis

Patients with cerebral palsy who develop functional quadriplegia are at an increased risk for recurrent urinary tract infections and kidney stones. Impaired bladder emptying, chronic constipation, and reduced physical mobility collectively promote urinary stasis and bacterial growth. Despite the frequency of these complications, there is little guidance in the currently available literature on how to select appropriate empiric oral antibiotics for pyelonephritis in this patient population, especially when renal stones are also present. This case highlights the importance of careful antibiotic selection in patients with neurogenic bladder and nephrolithiasis. Oral cefdinir demonstrates limited renal tissue penetration, which may reduce its effectiveness in treating complicated urinary tract infections. In contrast, fluoroquinolones provide superior penetration into renal tissue, making them a more suitable option in specific scenarios. Choosing antibiotics that align with the patient's clinical presentation and pharmacological requirements can significantly reduce recurrence and improve outcomes in quadriplegic patients with recurrent kidney stones. This case report demonstrates that selecting antibiotics with sufficient renal tissue penetration can improve outcomes in complicated pyelonephritis, with symptom resolution after antibiotic change.