Acute pyelonephritis is urgent and needs timely treatment. Before the bacterial culture was clarified, low-toxic broad-spectrum antibiotics were used according to the results of urine smear staining. For gram-positive cocci, vancomycin and broad-spectrum penicillin can be selected; Gram-negative bacilli can choose cephalosporins, aminoglycoside antibiotics or compound sulfamethoxazole, quinolones and other drugs.
Treatment lasts at least two weeks. The choice of antibiotics at this time depends entirely on the doctor's experience. Professor Ye of Sun Yat-sen University of Medical Sciences recommended the use of compound sulfamethoxazole, which is not inferior to aminoglycoside antibiotics, ampicillin and second and third generation cephalosporins, and has the following advantages: it is effective for most pathogens of urinary tract infection, and the drug concentration in urine and blood is high; Drug-resistant strains rarely appear after use; Except for individual allergies, there are few serious side effects; The nephrotoxicity is low, it can still be used for patients with renal insufficiency, and it will not increase the damage of renal function, and it can still maintain the effective bactericidal concentration of drugs in blood and urine of renal patients; It can be secreted in vaginal fluid to inhibit bacteria around vaginal vestibule and urethral orifice, thus reducing the chance of recurrence of urinary tract infection. When sulfamethoxazole is combined with trimethoprim, the bactericidal power can be increased several times; Adding sodium bicarbonate can not only alkalize urine and enhance the curative effect of sulfamethoxazole, but also prevent sulfamethoxazole from crystallizing in urine after long-term use. If patients are allergic to sulfonamides, many scholars have reported that quinolones have achieved satisfactory results in the treatment of urinary tract infections. The above medication methods are for reference only.
In addition, antibacterial drugs should last for two weeks after normal body temperature, disappearance of systemic symptoms and negative bacterial culture. Otherwise, it is easy to relapse, and it takes 4 ~ 6 weeks of treatment to recover.
The recurrence of upper urinary tract infection is mostly due to incomplete treatment, so some people advocate ct scanning to observe the absorption of lesions and monitor the therapeutic effect. Patients with renal insufficiency should carefully choose aminoglycosides and other nephrotoxic antibiotics, and use more antibiotics with less nephrotoxicity.