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Management of Antibiotic-Resistant Acute Pyelonephritis
Urogenit Tract Infect 2017 Dec;12(3):95-102
Published online December 31, 2017
Copyright © 2017 Korean Association of Urogenital Tract Infection and Inflammation.

Ha Na Lee, Hana Yoon1

Department of Urology, Seoul Metropolitan Seonam Hospital, Seoul, 1Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea
Correspondence to: Hana Yoon
Department of Urology, Ewha Womans University School of Medicine, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea
Tel: +82-2-2650-5157, Fax: +82-2-2654-3682, E-mail:
Received September 1, 2017; Revised September 30, 2017; Accepted October 7, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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

August 2018, 13 (2)

  • The official journal of

    The Korean Association of Urogenital Tract Infection and Inflammation

    The Korean Continence Society

    The Han-nam Urological Association

    The Korean Society of Geriatric Urological Care