Therapeutic Targets
- Elimination of the pathogens
- Avoidance of complications
Therapy recommendations
- Please note the different antibiotic recommendations for the following patient groups with uncomplicated UTI (urinary tract infection) or for uncomplicated and complicated pyelonephritis (see below).
- A. Nonpregnant premenopausal women (life stage: approximately ten to fifteen years before menopause/very last menstrual period) without other relevant concomitant diseases [standard group].
- B. Pregnant women without other relevant concomitant diseases,
- C. Postmenopausal women (period that begins when menstruation has been absent for at least one year) without other relevant concomitant diseases (local vaginal prophylactic estrogen therapy; see below).
- D. Younger men without other relevant concomitant diseases.
- E. Patients with diabetes mellitus and stable metabolic status without other relevant concomitant diseases.
- Children: calculated antibiotic therapy best immediately after confirming the diagnosis to avoid parenchymal damage to the kidneys; esp. in the case of
- See also under “Other therapy“.
Subsequent recommendations relate to pyelonephritis. For information on cystitis (cystitis), see the topic of the same name. Indications for antibiotic therapy
- In acute uncomplicated pyelonephritis, effective antibiotic therapy should be used as early as possible. (V-A)
- A. Nonpregnant premenopausal women without other relevant concomitant diseases.
- Premenopausal women with mild and moderate courses of pyelonephritis should be treated with oral antibiotics (5-10 days). In severe infections with accompanying systemic symptoms, such as nausea, vomiting, or circulatory instability, therapy should be started initially with high doses of parenteral antibiotics. (Ib-A)
- For uncomplicated pyelonephritis with mild to moderate courses, one of the following oral antibiotics should preferably be used: Cefpodoxime, Ceftibuten* , Ciprofloxacin, Levofloxacin (in alphabetical order). * in Germany no longer on the market (Ib-A).
- In uncomplicated pyelonephritis with a severe course, preferably one of the following parenteral antibiotics should be used: Cefotaxime, Ceftriaxone, Ciprofloxacin, Levofloxacin (in alphabetical order). (Ib-A)
- The following antibiotics should not be used as first-line agents in patients with severe courses of uncomplicated pyelonephritis: Amikacin, amoxicillin/clavulanic acid, cefepime, ceftazidime, ceftazidime/avibactam, ceftolozane/tazobactam, ertapenem, gentamicin, , imipenem/cilastatin, meropenem, piperacillin/tazobactam(in alphabetical order). (V-B)
- B. Pregnant women without other relevant concomitant diseases.
- Inpatient treatment of pyelonephritis should be considered in pregnancy. (V-A)
- Group 2 and 3 cephalosporins are essentially recommended for empiric therapy.
- C. Postmenopausal women without other relevant comorbidities.
- For antibiotic therapy of acute uncomplicated pyelonephritis, the recommended approach for postmenopausal women is the same as for premenopausal women.
- D. Younger men without other relevant concomitant diseases.
- For empiric oral therapy of mild and moderate acute uncomplicated pyelonephritis in younger men, fluoroquinolones are primarily recommended if the local Escherichia coli resistance rate is still below 10% (see “Further guidance” below).
- The duration of therapy is usually 5 to 10 days
- E. Patients with diabetes mellitus and stable metabolic status without other relevant concomitant diseases.
- If there is marked insulin resistance and impending organ complications and a tendency to metabolic decompensation, the patient should be considered for inpatient treatment.
Further notes
- Drug Safety Communication: because of the risk of serious complications, antibiotics from the fluoroquinolone group should no longer be used to treat sinusitis, bronchitis, and uncomplicated urinary tract infections.
- Cave: With cefepime and creatinine clearance < 50 ml/min, there is a risk of encephalopathy (collective term for abnormal brain changes) with impaired consciousness, confusion, hallucinations, stupor (state of extreme mental and motor numbness), and coma; also myoclonus (brief involuntary twitching of individual muscles or muscle groups) and seizures (incl. nonconvulsive status epilepticus/prolonged epileptic seizure) are possible.
Supplements (dietary supplements; vital substances)
Suitable supplements due topyelonephritis (inflammation of the renal pelvis) should contain the following vital substances:
- Probiotics
Suitable supplements for natural defense should contain the following vital substances:
- Vitamins (A, C, E, D3, B1, B2 B3, B5, B6, B12, folic acid, biotin).
- Trace elements (chromium, iron, copper, manganese, molybdenum, selenium, zinc).
- Omega-3 fatty acids (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)).
- Secondary plant compounds (eg beta-carotene, flavonoids, lycopene, polyphenols).
- Probiotics
Note: The listed vital substances are not a substitute for drug therapy. Dietary supplements are intended to supplement the general diet in the particular life situation.
