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Patients with suspected pyelonephritis need empirical gram-negative antibiotic coverage, but choosing the best drug can be tricky. Guidelines from the Infectious Diseases Society of America (IDSA), now almost 15 years old, suggest that for outpatients, fluoroquinolones or trimethoprim/sulfamethoxazole (TMP-SMX) are better options than penicillins or cephalosporins (NEJM JW Infect Dis Mar 2011 and Clin Infect Dis 2011; 52:561).
Researchers retrospectively evaluated this recommendation in 851 patients with pyelonephritis who were discharged from 11 emergency departments in the U.S. in 2021 to 2023. About 25% of patients had complicating factors such as diabetes or obstructing stones; about 15% of patients were men. About half received a single…