[Antibiotic treatment of pyelonephritis in adults]

The diagnostic criteria of acute pyelonephritis are well determined, but this is not the case with the drugs used in the initial treatment and the duration of therapy, notably since not all cases of this disease have the same severity. The antibiotics which fulfill the requirements for effectiveness and good tolerance include aminopenicillins alone or combined with clavulanic acid, aminosides alone or combined with aminopenicillins, carbapenems, 2nd and 3rd generation cephalosporins, cotrimoxazole and fluoroquinolones. Patients with severe pyelonephritis should be hospitalized and treated initially by the parenteral route later followed by the oral route. Patients whose pyelonephritis shows no sign of severity can be treated at home by the oral route. The duration of treatment (10 to 20 days) depends on the initial severity and course of the disease, on laboratory reports and, sometimes, on urinary tract imaging.