Abstract

Acute pyelonephritis (APN) is a common urinary tract infection that affects a large proportion of women. Although antimicrobial therapy is a successful treatment in most cases, empirically, antibiotic resistance has emerged as a serious issue, including high resistance rate of fluoroquinolone and the advent of extended-spectrum β-lactamase (ESBL)-producing organisms. Several agents can be considered for the management of antibiotic resistant APN. Fosfomycin trometamol is effective in treating ESBL-producing bacterial infection. Oral trimethoprim/sulfamethoxazole, β-lactam agents, such as cephalosporin, and fluoroquinolone can be regarded as appropriate agents if pathogen is susceptible. Carbapenem, such as imipenem, meropenem, and doripenem, is one of the best and widely used agents for treating antibiotic resistant APN. However, there have recently been concerns regarding the increased rates of resistance to carbapenems. Daptomycin, linezolid, and tigecycline can be considered as solutions to antibiotic resistant organisms. Antibiotic resistant APN should be treated as other systemic infections to prevent antibiotic overuse with proper treatment duration considering carbapenem-saving strategy.

• Keywords: Pyelonephritis; Drug resistance, microbial; Urinary tract infections