Pyelonephritis is considered one of the most common kidney diseases. Pathology is an extensive process. Inflammation covers the pelvis and calyx of the kidneys, as well as the connective (interstitial) tissue. Infection occurs either from the outside, through the urinary system, or through the hematogenous route (with blood flow) from other foci. Next, we will analyze how pyelonephritis manifests itself. Treatment, drugs for its elimination will also be described in the article.
General information
The main pathogens of pyelonephritis are bacteria of the staphylococcus group, Escherichia coli and Pseudomonas aeruginosa, protea, streptococci, enterococci. The development of pathology under the influence of fungi or viruses is much less common. Pyelonephritis is often provoked by microbial associations or pathogens of L-forms. The latter are characterized by a non-enveloping adaptive state, characterized by high resistance to drugs. This significantly complicates not only therapy, but also the diagnosis of pathology. The disease quickly moves from an acute to a chronic stage. In this regard, antibiotics for pyelonephritis of the kidneys should be prescribed as soon as possible.
Therapeutic measures
Any antibiotic with pyelonephritis should have a wide range of therapeutic activity, high bactericidal action, minimal nephrotoxicity. The medication should also be excreted in the urine in a large volume. The list of antibiotics that are prescribed for the described pathology includes aminopenicillins, protected penicillins, cephalosporins, carboxypenicillins, aminoglycosides, fluoroquinolones. Next, we consider which antibiotics for pyelonephritis are prescribed most often.
Aminopenicillins
Specialists today are trying not to prescribe these drugs for pyelonephritis. They are characterized by increased natural activity with respect to protea, E. coli, enterococci. Their main drawback is exposure to beta-lactamases, enzymes produced by a variety of clinically significant pathogens. Today, these antibiotics for inflammation of the kidneys are not recommended (except for pathology in pregnant women) due to the increased level of resistant (resistant) strains of E. coli (more than 30%) to them.
Protected Penicillins
These antibiotics for inflammation of the kidneys are considered the means of choice. Medications are highly active both with respect to gram-negative microorganisms producing beta-lactamases and gram-positive bacteria, including penicillin-resistant and coagulase-negative staphylococci. The resistance level of Escherichia coli strains to protected penicillins is relatively low. Often prescribed antibiotic for pyelonephritis Amoxicillin and Clavulanate. This combination is recommended by mouth at 625 mg / 3 p. / Day. or parenteral at 1.2 g / 3 p. / day. The duration of therapy is from seven to ten days. An innovative form of this combination is considered an antibiotic for pyelonephritis "Flemoklav Solutab". The medication has proven effectiveness in urinary tract infections. Means "Flemoklav Solutab" is allowed for use by patients from three months and pregnant.
Medications for complicated forms
In severe cases and with suspected infection caused by Pseudomonas aeruginosa, carboxypenicillins can be prescribed. In particular, it is such an antibiotic for pyelonephritis as Ticarcillin. In the same group is the tool "Carbenicillin". In addition to carboxypenicillins, ureidopenicillins may be recommended. They include such medicines as Azlocillin, Piperacillin. However, it should be noted that anti-Pseudomonas penicillins are not recommended as mono-agents. This is due to the high probability of the development of resistance of microorganisms to them during therapy. In the treatment of pyelonephritis, combinations of these medicines and beta-lactamase inhibitors are used. In particular, combinations of the following drugs are prescribed: Ticarcillin + clavulanic acid, Tazobactam + Piperacillin. Combinations of anti-Pseudomonas antibiotics with fluoroquinolones and aminoglycosides are also used. Such medications are also prescribed for severe hospital infectious pathologies of the urinary system.
Cephalosporins
These medicines have the ability to accumulate in the parenchyma of the kidneys and urine in sufficiently high concentrations. Cephalosporins are characterized by moderate nephrotoxicity. These medicines are in the leading place today in the frequency of administration in patients with pyelonephritis and urinary tract infections. There are several generations of cephalosporins. They are divided in accordance with the spectrum of action and the degree of resistance to beta-lactamases:
- 1st generation. These drugs have a relatively limited spectrum of activity. They act mainly on gram-positive cocci and are not used in the acute course of pathology.
- 2nd generation. These cephalosporins have a wider spectrum of effects. They are active against E. coli and a number of other enterobacteria. For drugs of this group include, for example, the drug "Cefuroxime".
- 3rd generation. Cephalosporins of this group are used for complicated infections. Medicines are prescribed both orally (Ceftibuten, Cefixim) and parenterally (Ceftriaxone, Cefotaxime). In the latter case, a longer half-life and the use of two pathways for excretion from the body: with urine and bile, are characteristic. In the group of third-generation cephalosporins, there are medications that are active against Pseudomonas aeruginosa. This, in particular, means such as Cefoperazone, Ceftazidime, as well as the inhibitor-protected drug Cefoperazone + Sulbactam.
- 4th generation. Cephalosporins of this group have all the properties of drugs of the previous category, but at the same time they are more active in relation to gram-positive cocci.
Aminoglycosides
These medications are recommended for complicated forms of pyelonephritis, as well as serious nosocomial infections. Aminoglycosides include such agents as Amikacin, Tobramycin, Netilmicin, Gentamicin. In severe cases, these medications are combined with cephalosporins and penicillins. Aminoglycosides are poorly absorbed from the digestive tract. In this regard, they are administered mainly parenterally. Withdrawal of drugs is carried out unchanged in the urine. For patients with renal failure, dosage adjustment is necessary. The disadvantages of aminoglycosides include their pronounced nephro- and ototoxicity. The frequency of hearing impairment in patients reaches 8%, and kidney damage (manifested in the form of neoliguric, usually reversible insufficiency) - 17%. This causes the need to ensure in the process of therapy control over the level of urea, potassium, creatinine. Due to the fact that the dependence of the severity of complications on the concentration of medications in the blood has been established, a single administration of the full daily dosage is used. Such a scheme, among other things, helps to reduce the likelihood of nephrotoxicity. The factors for the occurrence of this complication include:
- Repeated use of the drug with a break of less than a year.
- Old age.
- Long-term treatment with diuretics.
- Combined use with cephalosporins in high dosages.
Fluoroquinolones
These medications have been the drug of choice in recent years. They are prescribed both in outpatient and inpatient settings. The first generation fluoroquinolones include drugs such as Ciprofloxacin, Pefloxacin, Ofloxacin. They are active against most pathogens in the genitourinary system. The advantage of medicines is their low toxicity, long half-life, which, in turn, allows you to take them twice a day. Fluoroquinolones are satisfactorily tolerated by patients and form rather high concentrations in urine, renal tissue, and blood. Medicines are used both parenterally and orally, except for Norfloxacin (it is intended for oral administration). Second-generation fluoroquinolones (Lomefloxacin, Levofloxacin, Moxifloxacin and others) are more active in relation to gram-positive microorganisms, pneumococci, first of all. At the same time, they have the same effect as the previous generation drugs on gram-negative bacteria (except Pseudomonas aeruginosa).
Prevention of pyelonephritis
In order to avoid relapse or the primary occurrence of pathology, all possible provoking factors must be eliminated. Prevention of pyelonephritis includes a whole range of measures. This may include normalization of diet, rest and work, sleep and wakefulness. A prerequisite is the absolute exclusion of subcooling. Particular attention should be paid to the general condition of the body - it is important that there are no infections in it. In this regard, therapy should be carried out for probable diseases: colitis, caries, gastritis and others.