What is the inpatient treatment regimen for pyelonephritis?

The treatment regimen for inpatient pyelonephritis often emphasizes the use of broad-spectrum antibiotics to effectively target the likely pathogens, which primarily include Escherichia coli and other Gram-negative bacteria.

Ampicillin combined with gentamicin is a commonly chosen regimen for hospital management of pyelonephritis due to its effectiveness. Ampicillin provides coverage against enterococci and some Gram-negative organisms, and when paired with gentamicin, it enhances the treatment against more resistant strains of Gram-negative bacilli. This synergy is particularly beneficial in cases where there is a risk of complicated infections or when the patient presents with severe illness.

While other options like ciprofloxacin paired with metronidazole or vancomycin paired with ceftriaxone could be appropriate in certain situations, the choice of ampicillin and gentamicin is favored due to its specific coverage, particularly in healthcare settings where resistance patterns may vary, and it allows providers to cover both potential pyogenes and urinary pathogens effectively.

Piperacillin plus tazobactam is another strong option and can certainly be used in severe cases or those that may require more aggressive treatment. However, the combination of ampicillin and gentamicin is routinely a first-line approach for