Oral trimethoprim-sulfamethoxazole (160/800 mg [1 doublestrength
tablet] twice-daily for 14 days) may be used, but only
if the infecting organism is known to be susceptible. Patients
receiving this regimen should all receive a starting IV dose of
a long-acting antibiotic, e.g., 1 g of ceftriaxone or a consolidated
24-hour dose of an aminoglycoside. The guideline authors
give a weaker recommendation to use oral beta-lactams (e.g.,
amoxicillin-clavulanate, cefdinir, cefaclor, and cefpodoximeproxetil)
due to lower effectiveness. These should be taken for
10-14 days and may be considered in situations where there are
contraindications to the other treatment options. All patients
with pyelonephritis treated with oral beta-lactams should receive
a starting IV dose of a long-acting antibiotic as above.
days) are alternatives and may be given without consideration
of an initial IV dose unless fluoroquinolone resistance prevalence
exceeds 10%. In this case, as with the above situation,
a single initial IV dose of 1 g of ceftriaxone or a consolidated
24-hour dose of an aminoglycoside should start treatment.