Pyelonephritis presenting with fever and costovertebral angle tenderness is commonly treated with which regimen for 2 weeks?

Pyelonephritis presenting with fever and costovertebral angle tenderness is commonly treated with which regimen for 2 weeks?

• A. Ceftriaxone for 7 days
• B. Ampicillin plus an aminoglycoside for 2 weeks
• C. Nitrofurantoin for 5 days
• D. Amoxicillin alone for 10 days

Answer: (B)

Acute pyelonephritis needs antibiotics that penetrate the renal parenchyma and provide robust activity against gram-negative bacteria, often with coverage that addresses potential enterococcal involvement. Ampicillin plus an aminoglycoside fits this by pairing a beta-lactam that helps open the bacterial cell wall with a potent bactericidal agent against gram-negative rods; together they achieve rapid, synergistic killing and broad coverage suitable for a two-week course to reliably clear infection and resolve systemic symptoms. Nitrofurantoin is effective mainly for lower urinary tract infections and doesn’t achieve adequate tissue levels in the kidney, so it’s not appropriate for pyelonephritis. Ceftriaxone for seven days can be used in some settings, but the specified two-week duration is longer and the combination with an aminoglycoside provides the depth of coverage often emphasized for pyelonephritis. Amoxicillin alone is less reliable due to resistance among common uropathogens. When using an aminoglycoside, monitor kidney function and drug levels to minimize toxicity.

Acute pyelonephritis needs antibiotics that penetrate the renal parenchyma and provide robust activity against gram-negative bacteria, often with coverage that addresses potential enterococcal involvement. Ampicillin plus an aminoglycoside fits this by pairing a beta-lactam that helps open the bacterial cell wall with a potent bactericidal agent against gram-negative rods; together they achieve rapid, synergistic killing and broad coverage suitable for a two-week course to reliably clear infection and resolve systemic symptoms. Nitrofurantoin is effective mainly for lower urinary tract infections and doesn’t achieve adequate tissue levels in the kidney, so it’s not appropriate for pyelonephritis. Ceftriaxone for seven days can be used in some settings, but the specified two-week duration is longer and the combination with an aminoglycoside provides the depth of coverage often emphasized for pyelonephritis. Amoxicillin alone is less reliable due to resistance among common uropathogens. When using an aminoglycoside, monitor kidney function and drug levels to minimize toxicity.