Antibiotics for pyelonephritis: characteristics of drugs and treatment features. How are kidney pyelonephritis treated? Is it possible to cure chronic pyelonephritis completely?

Okorokov A. N.
Treatment of diseases of internal organs:
Practical guide. Volume 2.
Minsk - 1997.

Treatment of chronic pyelonephritis

Chronic pyelonephritis- a chronic nonspecific infectious-inflammatory process with predominant and initial damage to the interstitial tissue, pyelocaliceal system and renal tubules with subsequent involvement of the glomeruli and renal vessels.

Treatment program for chronic pyelonephritis.
1.
2.
3. (restoration of urine outflow and anti-infective therapy).
4.
5.
6.
7. .
8.
9.
10.
11.
12. .
13. Treatment of chronic renal failure (CRF).

1. Mode

The patient's regimen is determined by the severity of the condition, the phase of the disease (exacerbation or remission), clinical features, the presence or absence of intoxication, complications of chronic pyelonephritis, and the degree of chronic renal failure.

Indications for hospitalization of the patient are:

• severe exacerbation of the disease;
• development of difficult-to-correct arterial hypertension;
• progression of chronic renal failure;
• disturbance of urodynamics, requiring restoration of urine passage;
• clarification of the functional state of the kidneys;
• o development of an expert solution.

In any phase of the disease, patients should not be subjected to cooling; significant physical activity is also excluded.
With a latent course of chronic pyelonephritis with normal blood pressure or mild arterial hypertension, as well as with preserved renal function, regimen restrictions are not required.
During exacerbations of the disease, the regime is limited, and patients with a high degree of activity and fever are prescribed bed rest. Visits to the dining room and toilet are allowed. In patients with high arterial hypertension and renal failure, it is advisable to limit physical activity.
As the exacerbation is eliminated, the symptoms of intoxication disappear, blood pressure normalizes, and the symptoms of chronic renal failure decrease or disappear, the patient’s regimen expands.
The entire period of treatment for exacerbation of chronic pyelonephritis until the regime is fully expanded takes about 4-6 weeks (S.I. Ryabov, 1982).

In case of chronic pyelonephritis, it is advisable to prescribe predominantly acidifying foods (bread, flour products, meat, eggs) for 2-3 days, then an alkalizing diet (vegetables, fruits, milk) for 2-3 days. This changes the pH of the urine, the interstitium of the kidneys and creates unfavorable conditions for microorganisms.

3. Etiological treatment

Etiological treatment includes eliminating the causes that caused the disruption of urine passage or renal circulation, especially venous circulation, as well as anti-infective therapy.

Restoring the outflow of urine is achieved by using surgical interventions (removal of prostate adenoma, stones from the kidneys and urinary tract, nephropexy for nephroptosis, plastic surgery of the urethra or ureteropelvic segment, etc.), i.e. restoration of urine passage is necessary for so-called secondary pyelonephritis. Without sufficiently restored urine passage, the use of anti-infective therapy does not provide stable and long-term remission of the disease.

Anti-infective therapy for chronic pyelonephritis is the most important measure for both the secondary and primary variants of the disease (not associated with impaired urine outflow through the urinary tract). The choice of drugs is made taking into account the type of pathogen and its sensitivity to antibiotics, the effectiveness of previous courses of treatment, nephrotoxicity of drugs, the state of kidney function, the severity of chronic renal failure, the influence of urine reaction on the activity of drugs.

Chronic pyelonephritis is caused by a wide variety of flora. The most common pathogen is Escherichia coli, in addition, the disease can be caused by enterococcus, Proteus vulgaris, staphylococcus, streptococcus, Pseudomonas aeruginosa, mycoplasma, and less commonly by fungi and viruses.

Often chronic pyelonephritis is caused by microbial associations. In some cases, the disease is caused by L-forms of bacteria, i.e. transformed microorganisms with loss of cell wall. The L-form is an adaptive form of microorganisms in response to chemotherapeutic agents. Non-enveloped L-forms are inaccessible to the most commonly used antibacterial agents, but retain all toxic-allergic properties and are able to support the inflammatory process (while bacteria are not detected by conventional methods).

For the treatment of chronic pyelonephritis, various anti-infective drugs - uroantiseptics - are used.

The main causative agents of pyelonephritis are sensitive to the following uroantiseptics.
Escherichia coli: highly effective are chloramphenicol, ampicillin, cephalosporins, carbenicillin, gentamicin, tetracyclines, nalidixic acid, nitrofuran compounds, sulfonamides, phosphacin, nolicin, palin.
Enterobacter: highly effective chloramphenicol, gentamicin, palin; Tetracyclines, cephalosporins, nitrofurans, and nalidixic acid are moderately effective.
Proteus: ampicillin, gentamicin, carbenicillin, nolicin, palin are highly effective; Levomycetin, cephalosporins, nalidixic acid, nitrofurans, and sulfonamides are moderately effective.
Pseudomonas aeruginosa: gentamicin and carbenicillin are highly effective.
Enterococcus: ampicillin is highly effective; Carbenicillin, gentamicin, tetracyclines, and nitrofurans are moderately effective.
Staphylococcus aureus (does not form penicillinase): penicillin, ampicillin, cephalosporins, gentamicin are highly effective; Carbenicillin, nitrofurans, and sulfonamides are moderately effective.
Staphylococcus aureus (forming penicillinase): oxacillin, methicillin, cephalosporins, gentamicin are highly effective; Tetracyclines and nitrofurans are moderately effective.
Streptococcus: penicillin, carbenicillin, cephalosporins are highly effective; Ampicillin, tetracyclines, gentamicin, sulfonamides, nitrofurans are moderately effective.
Mycoplasma infection: tetracyclines and erythromycin are highly effective.

Active treatment with uroantiseptics must begin from the first days of exacerbation and continue until all signs of the inflammatory process are eliminated. After this, an anti-relapse course of treatment must be prescribed.

Basic rules for prescribing antibacterial therapy:
1. Correspondence of the antibacterial agent and the sensitivity of the urine microflora to it.
2. The dosage of the drug should be made taking into account the state of kidney function and the degree of chronic renal failure.
3. The nephrotoxicity of antibiotics and other uroantiseptics should be taken into account and the least nephrotoxic ones should be prescribed.
4. If there is no therapeutic effect, the drug should be changed within 2-3 days from the start of treatment.
5. In case of a high degree of activity of the inflammatory process, severe intoxication, severe course of the disease, or ineffectiveness of monotherapy, it is necessary to combine uroantiseptic agents.
6. It is necessary to strive to achieve a urine reaction that is most favorable for the action of the antibacterial agent.

The following antibacterial agents are used in the treatment of chronic pyelonephritis: antibiotics ( table 1), sulfonamide drugs, nitrofuran compounds, fluoroquinolones, nitroxoline, nevigramon, gramurin, palin.

3.1. Antibiotics

Table 1. Antibiotics for the treatment of chronic pyelonephritis

A drug	Daily dose
Penicillin group
Benzylpenicillin	Intramuscularly 500,000-1,000,000 units every 4 hours
Methicillin
Oxacillin	Intramuscularly 1 g every 6 hours
Dicloxacillin	Intramuscularly 0.5 g every 4 hours
Cloxacillin	Intramuscularly 1 g every 4-6 hours
Ampicillin	Intramuscularly 1 g every 6 hours, orally 0.5-1 g 4 times a day
Amoxicillin	Orally 0.5 g every 8 hours
Augmentin (amoxicillin + clavulanate)	Intramuscularly 1.2 g 4 times a day
Unazine (ampicillin + sulbactam)	Orally 0.375-0.75 g 2 times a day, intramuscularly 1.5-3 g 3-4 times a day
Ampiox (ampicillin + oxacillin)	Orally 0.5-1 g 4 times a day, intramuscularly 0.5-2 g 4 times a day
Carbenicillin	Intramuscularly, intravenously 1-2 g 4 times a day
Azlocillin	Intramuscularly 2 g every 6 hours or intravenously drip
Cephalosporins
Cefazolin (kefzol)	Intramuscularly, intravenously 1-2 g every 8-12 hours
Cephalothin	Intramuscularly, intravenously 0.5-2 g every 4-6 hours
Cephalexin
Cefuroxime (ketocef)	Intramuscularly, intravenously 0.75-1.5 g 3 times a day
Cefuroxime-axetil	Orally 0.25-0.5 g 2 times a day
Cefaclor (ceclor)	Orally 0.25-0.5 g 3 times a day
Cefotaxime (claforan)	Intramuscularly, intravenously 1-2 g 3 times a day
Ceftizoxime (epoceline)	Intramuscularly, intravenously 1-4 g 2-3 times a day
Ceftazidime (Fortum)	Intramuscularly, intravenously 1-2 g 2-3 times a day
Cephobid (cefoperazone)	Intramuscularly, intravenously 2-4 g 2-3 times a day
Ceftriaxone (Longacef)	Intramuscularly, intravenously 0.5-1 g 1-2 times a day
Carbapenems
Imipinem + cilastatin (1:1)	Intravenous drip of 0.5-1 g per 100 ml of 5% glucose solution or intramuscularly of 0.5-0.75 g every 12 hours with lidocaine
Monobactams
Aztreonam (azaktam)	Intramuscularly, intravenously 1-2 g every 6-8 hours or 0.5-1 g every 8-12 hours
Aminoglycosides
Gentamicin (Garamycin)
Tobramycin (brulamycin)	Intramuscularly, intravenously 3-5 mg/kg per day in 2-3 injections
Sizomycin	Intramuscular, intravenous drip in 5% glucose solution
Amikacin	Intramuscularly, intravenously 15 mg/kg per day in 2 doses
Tetracyclines
Metacycline (Rondomycin)	Orally 0.3 g 2 times a day 1-1.5 hours before meals
Doxycycline (vibramycin)	Orally, intravenously (drip) 0.1 g 2 times a day
Lincosamines
Lincomycin (lincocin)	Inside, intravenously, intramuscularly; orally 0.5 g 4 times a day; parenterally 0.6 g 2 times a day
Clindamycin (Dalacin)	Orally 0.15-0.45 g every 6 hours; intravenously, intramuscularly 0.6 g every 6-8 hours
Levomycetin group
Chloramphenicol (chloramphenicol)	Orally 0.5 g 4 times a day
Levomycetin succinate (chlorocide C)	Intramuscularly, intravenously 0.5-1 g 3 times a day
Fosfomycin (phosphocin)	Orally 0.5 g every 6 hours; intravenous stream, drip 2-4 g every 6-8 hours

3.1.1. Penicillin group drugs
In case of unknown etiology of chronic pyelonephritis (the causative agent has not been identified), it is better to choose penicillins with an extended spectrum of activity (ampicillin, amoxicillin) from the penicillin group of drugs. These drugs actively affect gram-negative flora, most gram-positive microorganisms, but staphylococci that produce penicillinase are not sensitive to them. In this case, they must be combined with oxacillin (Ampiox) or use highly effective combinations of ampicillin with beta-lactamase (penicillinase) inhibitors: unasin (ampicillin + sulbactam) or augmentin (amoxicillin + clavulanate). Carbenicillin and azlocillin have pronounced antipseudomonas activity.

3.1.2. Drugs of the cephalosporin group
Cephalosporins are very active, have a powerful bactericidal effect, have a wide antimicrobial spectrum (actively affect gram-positive and gram-negative flora), but have little or no effect on enterococci. Of the cephalosporins, only ceftazidime (Fortum) and cefoperazone (cephobid) have an active effect on Pseudomonas aeruginosa.

3.1.3. Carbapenem drugs
Carbapenems have a wide spectrum of action (gram-positive and gram-negative flora, including Pseudomonas aeruginosa and staphylococci that produce penicillinase - beta-lactamase).
When treating pyelonephritis from drugs in this group, imipinem is used, but always in combination with cilastatin, since cilastatin is a dehydropeptidase inhibitor and inhibits the renal inactivation of imipinem.
Imipinem is a reserve antibiotic and is prescribed for severe infections caused by multi-resistant strains of microorganisms, as well as for mixed infections.

3.1.4. Monobactam preparations
Monobactams (monocyclic beta-lactams) have a powerful bactericidal effect against gram-negative flora and are highly resistant to the action of penicillinases (beta-lactamases). Drugs in this group include aztreonam (azactam).

3.1.5. Aminoglycoside preparations
Aminoglycosides have a powerful and faster bactericidal effect than beta-lactam antibiotics and have a wide antimicrobial spectrum (gram-positive, gram-negative flora, Pseudomonas aeruginosa). You should be aware of the possible nephrotoxic effect of aminoglycosides.

3.1.6. Lincosamine preparations
Lincosamines (lincomycin, clindamycin) have a bacteriostatic effect and have a fairly narrow spectrum of activity (gram-positive cocci - streptococci, staphylococci, including those that produce penicillinase; non-spore-forming anaerobes). Lincosamines are not active against enterococci and gram-negative flora. Resistance of microflora, especially staphylococci, quickly develops to lincosamines. In severe cases of chronic pyelonephritis, lincosamines should be combined with aminoglycosides (gentamicin) or other antibiotics acting on gram-negative bacteria.

3.1.7. Levomycetin
Levomycetin is a bacteriostatic antibiotic, active against gram-positive, gram-negative, aerobic, anaerobic bacteria, mycoplasmas, chlamydia. Pseudomonas aeruginosa is resistant to chloramphenicol.

3.1.8. Fosfomycin
Fosfomycin is a bactericidal antibiotic with a wide spectrum of action (acts on gram-positive and gram-negative microorganisms, and is also effective against pathogens resistant to other antibiotics). The drug is excreted unchanged in the urine, therefore it is very effective for pyelonephritis and is even considered a reserve drug for this disease.

3.1.9. Accounting for urine reaction
When prescribing antibiotics for pyelonephritis, the urine reaction should be taken into account.
With an acidic urine reaction, the effect of the following antibiotics is enhanced:
- penicillin and its semisynthetic preparations;
- tetracyclines;
- novobiocin.
When urine is alkaline, the effect of the following antibiotics is enhanced:
- erythromycin;
- oleandomycin;
- lincomycin, dalacin;
- aminoglycosides.
Drugs whose action does not depend on the reaction of the environment:
- chloramphenicol;
- ristomycin;
- vancomycin.

3.2. Sulfonamides

Sulfonamides are used less frequently than antibiotics in the treatment of patients with chronic pyelonephritis. They have bacteriostatic properties and act on gram-positive and gram-negative cocci, gram-negative “bacillus” (Escherichia coli), and chlamydia. However, enterococci, Pseudomonas aeruginosa, and anaerobes are not sensitive to sulfonamides. The effect of sulfonamides increases with alkaline urine.

Urosulfan - 1 g is prescribed 4-6 times a day, while a high concentration of the drug is created in the urine.

Combined preparations of sulfonamides with trimethoprim are characterized by synergism, a pronounced bactericidal effect and a wide spectrum of activity (gram-positive flora - streptococci, staphylococci, including penicillinase-producing ones; gram-negative flora - bacteria, chlamydia, mycoplasma). The drugs do not act on Pseudomonas aeruginosa and anaerobes.
Bactrim (Biseptol) is a combination of 5 parts sulfamethoxazole and 1 part trimethoprim. Prescribed orally in tablets of 0.48 g, 5-6 mg/kg per day (in 2 doses); intravenously in ampoules of 5 ml (0.4 g of sulfamethoxazole and 0.08 g of trimethoprim) in isotonic sodium chloride solution 2 times a day.
Groseptol (0.4 g of sulfamerazole and 0.08 g of trimethoprim in 1 tablet) is prescribed orally 2 times a day at an average dose of 5-6 mg/kg per day.
Lidaprim is a combination drug containing sulfametrol and trimethoprim.

These sulfonamides dissolve well in urine and almost do not precipitate in the form of crystals in the urinary tract, but it is still advisable to wash down each dose with soda water. It is also necessary to monitor the number of leukocytes in the blood during treatment, as leukopenia may develop.

3.3. Quinolones

Quinolones are based on 4-quinolone and are classified into two generations:
I generation:
- nalidixic acid (nevigramone);
- oxolinic acid (gramurin);
- pipemidic acid (palin).
II generation (fluoroquinolones):
- ciprofloxacin (ciprobay);
- ofloxacin (Tarivid);
- pefloxacin (abactal);
- norfloxacin (nolitsin);
- lomefloxacin (maxaquin);
- enoxacin (Penetrex).

3.3.1. I generation quinolones
Nalidixic acid (nevigramon, negram) - the drug is effective against urinary tract infections caused by gram-negative bacteria, except Pseudomonas aeruginosa. Ineffective against gram-positive bacteria (staphylococcus, streptococcus) and anaerobes. It has a bacteriostatic and bactericidal effect. When taking the drug orally, a high concentration of it is created in the urine.
When urine becomes alkaline, the antimicrobial effect of nalidixic acid increases.
Available in capsules and tablets of 0.5 g. Prescribed orally, 1-2 tablets 4 times a day for at least 7 days. For long-term treatment, use 0.5 g 4 times a day.
Possible side effects of the drug: nausea, vomiting, headache, dizziness, allergic reactions (dermatitis, fever, eosinophilia), increased skin sensitivity to sunlight (photodermatoses).
Contraindications to the use of nevigramon: impaired liver function, renal failure.
Nalidixic acid should not be prescribed simultaneously with nitrofurans, as this reduces the antibacterial effect.

Oxolinic acid (gramurin) - according to the antimicrobial spectrum, gramurin is close to nalidixic acid, it is effective against gram-negative bacteria (Escherichia coli, Proteus), Staphylococcus aureus.
Available in tablets of 0.25 g. Prescribed 2 tablets 3 times a day after meals for at least 7-10 days (up to 2-4 weeks).
The side effects are the same as when treated with Nevigramon.

Pipemidic acid (palin) is effective against gram-negative flora, as well as pseudomonas, staphylococci.
Available in capsules of 0.2 g and tablets of 0.4 g. Prescribed 0.4 g 2 times a day for 10 days or more.
The drug is well tolerated, sometimes there is nausea and allergic skin reactions.

3.3.2. II generation quinolones (fluoroquinolones)
Fluoroquinolones are a new class of synthetic broad-spectrum antibacterial agents. Fluoroquinolones have a wide spectrum of action, they are active against gram-negative flora (Escherichia coli, Enterobacter, Pseudomonas aeruginosa), gram-positive bacteria (staphylococcus, streptococcus), legionella, mycoplasma. However, enterococci, chlamydia, and most anaerobes are insensitive to them. Fluoroquinolones penetrate well into various organs and tissues: lungs, kidneys, bones, prostate, and have a long half-life, so they can be used 1-2 times a day.
Side effects (allergic reactions, dyspeptic disorders, dysbacteriosis, agitation) are quite rare.

Ciprofloxacin (Ciprobay) is the “gold standard” among fluoroquinolones, as its antimicrobial action is superior to many antibiotics.
Available in tablets of 0.25 and 0.5 g and in bottles with an infusion solution containing 0.2 g of cyprobay. It is prescribed orally, regardless of food intake, 0.25-0.5 g 2 times a day; in case of very severe exacerbation of pyelonephritis, the drug is first administered intravenously in a drip of 0.2 g 2 times a day, and then oral administration is continued.

Ofloxacin (Tarivid) - available in tablets of 0.1 and 0.2 g and in vials for intravenous administration of 0.2 g.
Most often, ofloxacin is prescribed at a dose of 0.2 g 2 times a day orally; for very severe infections, the drug is first administered intravenously at a dose of 0.2 g 2 times a day, then switched to oral administration.

Pefloxacin (abactal) - available in tablets of 0.4 g and ampoules of 5 ml containing 400 mg of abactal. It is prescribed orally 0.2 g 2 times a day with meals; in severe cases, 400 mg is administered intravenously in 250 ml of 5% glucose solution (abactal cannot be dissolved in saline solutions) in the morning and evening, and then switched to oral administration.

Norfloxacin (nolicin) - available in tablets of 0.4 g, prescribed orally at 0.2-0.4 g 2 times a day, for acute urinary tract infections for 7-10 days, for chronic and recurrent infections - up to 3 months.

Lomefloxacin (Maxaquin) - available in tablets of 0.4 g, prescribed orally at 400 mg once a day for 7-10 days, in severe cases it can be used for a longer period (up to 2-3 months).

Enoxacin (Penetrex) - available in tablets of 0.2 and 0.4 g, administered orally at 0.2-0.4 g 2 times a day, cannot be combined with NSAIDs (convulsions may occur).

Due to the fact that fluoroquinolones have a pronounced effect on the causative agents of urinary infections, they are considered as the drug of choice in the treatment of chronic pyelonephritis. For uncomplicated urinary infections, a three-day course of treatment with fluoroquinolones is considered sufficient; for complicated urinary infections, treatment is continued for 7-10 days; for chronic urinary tract infections, longer use is possible (3-4 weeks).

It has been established that it is possible to combine fluoroquinolones with bactericidal antibiotics - antipseudomonas penicillins (carbenicillin, azlocillin), ceftazidime and imipenem. These combinations are prescribed when bacterial strains resistant to fluoroquinolone monotherapy appear.
It should be emphasized the low activity of fluoroquinolones against pneumococcus and anaerobes.

3.4. Nitrofuran compounds

Nitrofuran compounds have a wide spectrum of activity (gram-positive cocci - streptococci, staphylococci; gram-negative bacilli - Escherichia coli, Proteus, Klebsiella, Enterobacter). Anaerobes and Pseudomonas are insensitive to nitrofuran compounds.
During treatment, nitrofuran compounds may have undesirable side effects: dyspeptic disorders;
hepatotoxicity; neurotoxicity (damage to the central and peripheral nervous system), especially with renal failure and long-term treatment (more than 1.5 months).
Contraindications to the use of nitrofuran compounds: severe liver pathology, renal failure, diseases of the nervous system.
The following nitrofuran compounds are most often used in the treatment of chronic pyelonephritis.

Furadonin - available in tablets of 0.1 g; is well absorbed from the gastrointestinal tract, creates low concentrations in the blood, high concentrations in the urine. Prescribed orally 0.1-0.15 g 3-4 times a day during or after meals. The duration of the course of treatment is 5-8 days; if there is no effect during this period, it is not advisable to continue treatment. The effect of furadonin is enhanced by acidic urine and weakened by urine pH > 8.
The drug is recommended for chronic pyelonephritis, but is not advisable for acute pyelonephritis, since it does not create a high concentration in the kidney tissue.

Furagin - compared to furadonin, is better absorbed from the gastrointestinal tract and is better tolerated, but its concentrations in urine are lower. Available in tablets and capsules of 0.05 g and in powder form in jars of 100 g.
Used orally at 0.15-0.2 g 3 times a day. The duration of treatment is 7-10 days. If necessary, the course of treatment is repeated after 10-15 days.
In case of severe exacerbation of chronic pyelonephritis, soluble furagin or solafur can be administered intravenously (300-500 ml of 0.1% solution during the day).

Nitrofuran compounds combine well with aminoglycoside antibiotics and cephalosporins, but do not combine with penicillins and chloramphenicol.

3.5. Quinolines (8-hydroxyquinoline derivatives)

Nitroxoline (5-NOK) - available in tablets of 0.05 g. It has a wide spectrum of antibacterial action, i.e. affects gram-negative and gram-positive flora, is quickly absorbed from the gastrointestinal tract, excreted unchanged by the kidneys and creates a high concentration in the urine.
Prescribed orally 2 tablets 4 times a day for at least 2-3 weeks. In resistant cases, 3-4 tablets are prescribed 4 times a day. If necessary, it can be used long-term in courses of 2 weeks per month.
The toxicity of the drug is insignificant, side effects are possible; gastrointestinal disorders, skin rashes. When treated with 5-NOK, the urine becomes saffron yellow.

When treating patients with chronic pyelonephritis, the nephrotoxicity of drugs should be taken into account and preference should be given to the least nephrotoxic ones - penicillin and semisynthetic penicillins, carbenicillin, cephalosporins, chloramphenicol, erythromycin. The group of aminoglycosides is the most nephrotoxic.

If it is impossible to determine the causative agent of chronic pyelonephritis or before obtaining antibiogram data, broad-spectrum antibacterial drugs should be prescribed: ampiox, carbenicillin, cephalosporins, quinolones, nitroxoline.

With the development of chronic renal failure, the doses of urinary antiseptics are reduced and the intervals are increased (see "Treatment of chronic renal failure"). Aminoglycosides are not prescribed for chronic renal failure; nitrofuran compounds and nalidixic acid can be prescribed for chronic renal failure only in the latent and compensated stages.

Taking into account the need for dose adjustment in chronic renal failure, four groups of antibacterial agents can be distinguished:

• antibiotics, the use of which is possible in normal doses: dicloxacillin, erythromycin, chloramphenicol, oleandomycin;
• antibiotics, the dose of which is reduced by 30% when the urea content in the blood increases by more than 2.5 times compared to the norm: penicillin, ampicillin, oxacillin, methicillin; these drugs are not nephrotoxic, but in chronic renal failure they accumulate and cause side effects;
• antibacterial drugs, the use of which in chronic renal failure requires mandatory dose adjustment and administration intervals: gentamicin, carbenicillin, streptomycin, kanamycin, biseptol;
• antibacterial agents, the use of which is not recommended for severe chronic renal failure: tetracyclines (except doxycycline), nitrofurans, nevigramon.

Treatment with antibacterial agents for chronic pyelonephritis is carried out systematically and for a long time. The initial course of antibacterial treatment is 6-8 weeks, during which time it is necessary to achieve suppression of the infectious agent in the kidney. As a rule, during this period it is possible to achieve the elimination of clinical and laboratory manifestations of the activity of the inflammatory process. In severe cases of the inflammatory process, various combinations of antibacterial agents are used. A combination of penicillin and its semisynthetic drugs is effective. Nalidixic acid preparations can be combined with antibiotics (carbenicillin, aminoglycosides, cephalosporins). 5-NOK is combined with antibiotics. Bactericidal antibiotics (penicillins and cephalosporins, penicillins and aminoglycosides) combine well and mutually enhance the effect.

After the patient reaches remission, antibacterial treatment should be continued in intermittent courses. Repeated courses of antibacterial therapy for patients with chronic pyelonephritis must be prescribed 3-5 days before the expected appearance of signs of exacerbation of the disease so that the remission phase is constantly maintained for a long time. Repeated courses of antibacterial treatment are carried out for 8-10 days with drugs to which the sensitivity of the causative agent of the disease was previously revealed, since there is no bacteriuria in the latent phase of inflammation and during remission.

Methods of anti-relapse courses for chronic pyelonephritis are outlined below.

A. Ya. Pytel recommends treating chronic pyelonephritis in two stages. During the first period, treatment is carried out continuously, replacing the antibacterial drug with another every 7-10 days until the permanent disappearance of leukocyturia and bacteriuria occurs (for a period of at least 2 months). After this, intermittent treatment with antibacterial drugs is carried out for 4-5 months for 15 days at intervals of 15-20 days. In case of stable long-term remission (after 3-6 months of treatment), antibacterial agents may not be prescribed. After this, anti-relapse treatment is carried out - sequential (3-4 times a year) course use of antibacterial agents, antiseptics, and medicinal plants.

4. Use of NSAIDs

In recent years, the possibility of using NSAIDs for chronic pyelonephritis has been discussed. These drugs have an anti-inflammatory effect due to a decrease in the energy supply to the site of inflammation, reduce capillary permeability, stabilize lysosome membranes, cause a mild immunosuppressant effect, antipyretic and analgesic effect.
In addition, the use of NSAIDs is aimed at reducing reactive phenomena caused by the infectious process, preventing proliferation, and destroying fibrous barriers so that antibacterial drugs reach the inflammatory focus. However, it has been established that long-term use of indomethacin can cause necrosis of the renal papillae and impaired hemodynamics of the kidney (Yu. A. Pytel).
Of the NSAIDs, the most appropriate is to take voltaren (diclofenac sodium), which has a powerful anti-inflammatory effect and is the least toxic. Voltaren is prescribed 0.25 g 3-4 times a day after meals for 3-4 weeks.

5.Improving renal blood flow

Impaired renal blood flow plays an important role in the pathogenesis of chronic pyelonephritis. It has been established that with this disease there is an uneven distribution of renal blood flow, which is expressed in hypoxia of the cortex and phlebostasis in the medullary substance (Yu. A. Pytel, I. I. Zolotarev, 1974). In this regard, in the complex therapy of chronic pyelonephritis, it is necessary to use drugs that correct circulatory disorders in the kidney. For this purpose, the following means are used.

Trental (pentoxifylline) - increases the elasticity of red blood cells, reduces platelet aggregation, enhances glomerular filtration, has a mild diuretic effect, increases the delivery of oxygen to the area of ​​tissue affected by ischemia, as well as the pulse blood supply to the kidney.
Trental is prescribed orally at 0.2-0.4 g 3 times a day after meals, after 1-2 weeks the dose is reduced to 0.1 g 3 times a day. The duration of treatment is 3-4 weeks.

Curantil - reduces platelet aggregation, improves microcirculation, prescribed 0.025 g 3-4 times a day for 3-4 weeks.

Venoruton (troxevasin) - reduces capillary permeability and edema, inhibits platelet and erythrocyte aggregation, reduces ischemic tissue damage, increases capillary blood flow and venous outflow from the kidney. Venoruton is a semi-synthetic derivative of rutin. The drug is available in capsules of 0.3 g and ampoules of 5 ml of 10% solution.
Yu. A. Pytel and Yu. M. Esilevsky propose, in order to reduce the treatment time for exacerbation of chronic pyelonephritis, to prescribe venoruton intravenously in addition to antibacterial therapy at a dose of 10-15 mg/kg for 5 days, then orally at a dose of 5 mg/kg 2 times a day day throughout the course of treatment.

Heparin - reduces platelet aggregation, improves microcirculation, has anti-inflammatory and anti-complementary, immunosuppressant effects, inhibits the cytotoxic effect of T-lymphocytes, and in small doses protects the vascular intima from the damaging effects of endotoxin.
In the absence of contraindications (hemorrhagic diathesis, gastric and duodenal ulcers), heparin can be prescribed against the background of complex therapy for chronic pyelonephritis, 5000 units 2-3 times a day under the skin of the abdomen for 2-3 weeks, followed by a gradual reduction in dose over 7-10 days until complete cancellation.

6. Functional passive kidney exercises

The essence of functional passive kidney exercises is the periodic alternation of functional load (due to the administration of saluretic) and a state of relative rest. Saluretics, causing polyuria, contribute to the maximum mobilization of all the reserve capabilities of the kidney by including a large number of nephrons in the activity (under normal physiological conditions, only 50-85% of the glomeruli are in an active state). With functional passive exercises of the kidneys, not only diuresis is increased, but also renal blood flow. Due to the resulting hypovolemia, the concentration of antibacterial substances in the blood serum and in the kidney tissue increases, and their effectiveness in the area of ​​inflammation increases.

Lasix is ​​usually used as a means of functional passive kidney exercises (Yu. A. Pytel, I. I. Zolotarev, 1983). Prescribed 2-3 times a week 20 mg of Lasix intravenously or 40 mg of furosemide orally with monitoring of daily diuresis, electrolyte levels in the blood serum and biochemical blood parameters.

Negative reactions that may occur during passive kidney exercises:

• long-term use of the method can lead to depletion of the reserve capacity of the kidneys, which is manifested by a deterioration in their function;
• uncontrolled passive kidney exercises can lead to water and electrolyte imbalance;
• Passive kidney exercises are contraindicated in cases of impaired urine passage from the upper urinary tract.

7. Herbal medicine

In the complex therapy of chronic pyelonephritis, drugs are used that have an anti-inflammatory, diuretic, and, in the case of hematuria, a hemostatic effect ( table 2).

Table 2. Medicinal plants used for chronic pyelonephritis

Plant name	Action
	diuretic	bactericidal	astringent	hemostatic
Althea Cowberry Black elderberry Elecampane St. John's wort Corn silk Nettle Angelica root Birch leaves Wheatgrass Kidney tea Horsetail Chamomile Rowan Bearberry Cornflower flowers Cranberry Strawberry leaf	- ++ ++ ++ + ++ - ++ ++ ++ +++ +++ - ++ +++ ++ + +	++ ++ + + +++ ++ ++ - - - - + ++ + ++ + + -	- - + - ++ + + - - - - + - + + - - -	- - - + + + +++ - - - - ++ - ++ - - - ++

Bearberry (bear ears) - contains arbutin, which is broken down in the body into hydroquinone (an antiseptic that has an antibacterial effect in the urinary tract) and glucose. Used in the form of decoctions (30 g per 500 ml) 2 tablespoons 5-6 times a day. Bearberry exhibits its effect in an alkaline environment, so taking the decoction should be combined with ingesting alkaline mineral waters (Borjomi) and soda solutions. To alkalize urine, use apples, pears, and raspberries.

Lingonberry leaves have antimicrobial and diuretic effects. The latter is due to the presence of hydroquinone in lingonberry leaves. Used as a decoction (2 tablespoons per 1.5 cups of water). Prescribed 2 tablespoons 5-6 times a day. Just like bearberry, it works better in an alkaline environment. Alkalinization of urine is carried out in the same way as described above.

Cranberry juice, fruit drink (contains sodium benzoate) - has an antiseptic effect (synthesis in the liver from benzoate of hippuric acid increases, which, when excreted in the urine, causes a bacteriostatic effect). Take 2-4 glasses per day.

For the treatment of chronic pyelonephritis, the following preparations are recommended (E. A. Ladynina, R. S. Morozova, 1987).

Collection No. 1

Collection No. 2

Collection No. 3

In case of exacerbation of chronic pyelonephritis, accompanied by an alkaline reaction, it is advisable to use the following collection:

Collection No. 4

The following collection is recommended as maintenance antibiotic therapy:

Collection No. 5

It is considered appropriate for chronic pyelonephritis to prescribe combinations of herbs as follows: one diuretic and two bactericidal for 10 days (for example, cornflower flowers - lingonberry leaves - bearberry leaves), and then two diuretics and one bactericidal (for example, cornflower flowers - birch leaves - leaves bearberry). Treatment with medicinal plants takes a long time - months and even years.
During the entire autumn season, it is advisable to eat watermelons due to their pronounced diuretic effect.

Along with taking infusions, baths with medicinal plants are useful:

Collection No. 6(for Bath)

8. Increasing the general reactivity of the body and immunomodulatory therapy

In order to increase the body's reactivity and to quickly stop an exacerbation, the following are recommended:

• multivitamin complexes;
• adaptogens (tincture of ginseng, Chinese magnolia vine, 30-40 drops 3 times a day) during the entire period of treatment of an exacerbation;
• methyluracil 1 g 4 times a day for 15 days.

In recent years, a major role of autoimmune mechanisms in the development of chronic pyelonephritis has been established. Autoimmune reactions are promoted by a deficiency of T-suppressor function of lymphocytes. Immunomodulators are used to eliminate immune disorders. They are prescribed for long-term, poorly controlled exacerbation of chronic pyelonephritis. The following drugs are used as immunomodulators.

Levamisole (decaris) - stimulates the function of phagocytosis, normalizes the function of T- and B-lymphocytes, increases the interferon-producing ability of T-lymphocytes. Prescribed 150 mg once every 3 days for 2-3 weeks under the control of the number of leukocytes in the blood (there is a danger of leukopenia).

Timalin - normalizes the function of T- and B-lymphocytes, administered intramuscularly at 10-20 mg once a day for 5 days.

T-activin - the mechanism of action is the same, applied intramuscularly at 100 mcg once a day for 5-6 days.

By reducing the severity of autoimmune reactions and normalizing the functioning of the immune system, immunomodulators contribute to the rapid relief of exacerbations of chronic pyelonephritis and reduce the number of relapses. During treatment with immunomodulators, it is necessary to monitor the immune status.

9. Physiotherapeutic treatment

Physiotherapeutic treatment is used in the complex therapy of chronic pyelonephritis.
Physiotherapeutic techniques have the following effects:
- increase blood supply to the kidney, increase renal plasma flow, which improves the delivery of antibacterial agents to the kidneys;
- relieve spasm of the smooth muscles of the renal pelvis and ureters, which promotes the discharge of mucus, urinary crystals, and bacteria.

The following physiotherapy procedures are used.
1. Electrophoresis of furadonin on the kidney area. The solution for electrophoresis contains: furadonin - 1 g, 1N NaOH solution - 2.5 g, distilled water - 100 ml. The drug moves from the cathode to the anode. The course of treatment consists of 8-10 procedures.
2. Electrophoresis of erythromycin on the kidney area. The solution for electrophoresis contains: erythromycin - 100,000 units, ethyl alcohol 70% - 100 g. The drug moves from the anode to the cathode.
3. Calcium chloride electrophoresis on the kidney area.
4. USV at a dose of 0.2-0.4 W/cm 2 in pulse mode for 10-15 minutes in the absence of urolithiasis.
5. Centimeter waves (“Luch-58”) to the kidney area, 6-8 procedures per course of treatment.
6. Thermal procedures on the area of ​​the diseased kidney: diathermy, therapeutic mud, diathermo mud, ozokerite and paraffin applications.

10. Symptomatic treatment

With the development of arterial hypertension, antihypertensive drugs are prescribed (reserpine, adelfan, brinerdine, cristepine, dopegit), with the development of anemia - iron-containing drugs, with severe intoxication - intravenous drip infusion of hemodez, neocompensan.

11. Spa treatment

The main sanatorium-resort factor for chronic pyelonephritis is mineral waters, which are used internally and in the form of mineral baths.

Mineral waters have an anti-inflammatory effect, improve renal plasma flow, glomerular filtration, have a diuretic effect, promote the excretion of salts, and affect urine pH (shift the urine reaction to the alkaline side).

The following resorts with mineral waters are used: Zheleznovodsk, Truskavets, Jermuk, Sairme, Berezovsky mineral waters, Slavyanovsky and Smirnovsky mineral springs.

Mineral water "Naftusya" of the Truskavets resort reduces spasm of the smooth muscles of the renal pelvis and ureters, which promotes the passage of small stones. In addition, it also has an anti-inflammatory effect.

“Smirnovskaya” and “Slavyanovskaya” mineral waters are hydrocarbonate-sulfate-sodium-calcium, which determines their anti-inflammatory effect.

Taking mineral waters internally helps reduce inflammation in the kidneys and urinary tract, “washing out” mucus, microbes, small stones, and “sand” from them.

At resorts, treatment with mineral waters is combined with physiotherapeutic treatment.

Contraindications to sanatorium-resort treatment are:
- high arterial hypertension;
- severe anemia;
- Chronic renal failure.

12. Planned anti-relapse treatment

The goal of planned anti-relapse treatment is to prevent the development of relapse and exacerbation of chronic pyelonephritis. There is no unified system of anti-relapse treatment.

O. L. Tiktinsky (1974) recommends the following method of anti-relapse treatment:
1st week - biseptol (1-2 tablets at night);
2nd week - herbal uroantiseptic;
3rd week - 2 tablets of 5-NOK at night;
4th week - chloramphenicol (1 tablet at night).
In subsequent months, maintaining the specified sequence, you can replace the drugs with similar ones from the same group. If there is no exacerbation within 3 months, you can switch to herbal uroantiseptics for 2 weeks a month. A similar cycle is repeated, after which, in the absence of exacerbation, breaks in treatment lasting 1-2 weeks are possible.

There is another option for anti-relapse treatment:
1st week - cranberry juice, rosehip infusions, multivitamins;
2nd and 3rd weeks - medicinal mixtures (horsetail, juniper fruits, licorice root, birch leaves, bearberry, lingonberry, celandine herb);
4th week - antibacterial drug, changing every month.

Pyelonephritis is a nonspecific infectious and inflammatory disease of the kidneys with damage mainly to the parenchyma, pelvis and calyx and the further development of secondary nephrosclerosis. It is the most common kidney pathology among all age groups. Young and middle-aged men get sick 6 times less often than women. With timely treatment, stable remission of the disease can be achieved.

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  Basic Concepts

  Pyelonephritis is a nonspecific inflammatory process of bacterial etiology with damage to the renal tubular system, damage to the kidney parenchyma (mainly its interstitial tissue), calyces and renal pelvis (pyelitis).

  The main causative agents of the disease include gram-negative bacteria of the intestinal group, enterococci, staphylococci, streptococci, Pseudomonas aeruginosa, viruses, Proteus, mycoplasma, candida and many others.

  Infection occurs in three ways:

  • lymphogenous;
  • urogenic (through the urethra, bladder and ureters);
  • hematogenous.

  In men, the latter route of infection predominates due to bacteremia (in the presence of a chronic or acute infection in the body - osteomyelitis, appendicitis, etc.).

  Predisposing factors are considered:

  • kidney development abnormalities;
  • concomitant chronic diseases;
  • metabolic disorders (diabetes mellitus, gout);
  • unprotected sexual intercourse;
  • obstruction of the urinary tract;
  • vesicoureteral reflux.

  Consequences of vesicoureteral reflux

  The main reasons for the development of pyelonephritis:

  • metabolic toxins (hypercalcemia, gout, oxalaturia, etc.);
  • exogenous toxins (heavy metals, analgesics, antibacterial agents);
  • vascular disorders (nephrosclerosis, acute tubular necrosis);
  • neoplasms (lymphoma, myeloma, leukemia);
  • immune disorders (amyloidosis, glomerulosclerosis, Sjogren's disease);
  • hereditary kidney diseases (polycystic disease);
  • mixed pathologies (vesicoureteral reflux, urinary tract obstruction, radiation nephritis).

  

  Classification

  Based on excisional and puncture biopsy of kidney tissue, 3 main variants of the course of the disease are determined:

  • spicy;
  • chronic;
  • chronic with rare and frequent exacerbations.

  Depending on the etiology, primary and secondary forms are considered. Based on localization, unilateral and bilateral pyelonephritis is distinguished. In form - obstructive and non-obstructive. The causes of obstructive pyelonephritis are always urodynamic disorders (vesicoureteral reflux) and mechanical factors of occlusion of the upper urinary tract (inflammatory detritus, stones, strictures of the ureter, compression from the outside, blood clots, etc.), resulting in disturbances in the excretion of urine from the kidneys to the bladder. The non-obstructive type of the disease develops in the absence of structural and functional damage in the kidneys and urinary tract.

  Both primary and secondary acute pyelonephritis usually first occur as a serous process, and then turn into a form of purulent interstitial inflammation. As a rule, serous pyelonephritis, in the absence of timely and adequate treatment, becomes purulent. In this regard, it is customary to use the terms “acute serous pyelonephritis” and “acute purulent pyelonephritis”. The latter is presented in the form of an abscess, apostematous nephritis and renal carbuncle.

  may arise as a result of an acute process or develop as a primary chronic one.

  As the chronic disease progresses, arteriolar sclerosis and further atrophy of the kidney parenchyma develop, which ultimately ends in pyelonephritic wrinkling and renal failure.

  

  Clinical manifestations

  The symptoms of the disease are quite diverse. The disease is characterized by several clinical and laboratory syndromes:

  Syndromes	Manifestations
  Painful	Pain in the lumbar region on the affected side is characteristic: in obstructive forms they are usually acute, prolonged, paroxysmal (for example, with obstruction of a ureteral stone with the development of calculous pyelonephritis); with non-obstructive pyelonephritis, the pain is dull, intermittent, aching, of low intensity or reaches high severity, sometimes taking on a paroxysmal character. When tapping in the lumbar region (), discomfort appears from the affected kidney
  Inflammatory	Characterized by headache, increased fatigue, lethargy, decreased performance, increased body temperature up to febrile levels (usually in the evening), chills, decreased appetite, aching pain in the lower back
  Uric	Severe bacteriuria and leukocyturia, pollakiuria (frequent urination), polyuria, nocturia (predominance over daytime), microhematuria, slight proteinuria, isosthenuria
  Chronic renal failure syndrome	Dry skin, pallor, nausea and vomiting, anorexia, nosebleeds, renal osteodystrophy, acidosis, specific odor of ammonia from the mouth (sweetish), uremia
  Changes in the blood	Anemia, leukocytosis with a shift to the left, urea and residual nitrogen

  Upon examination, puffiness of the face, pale skin with a yellowish tint, swelling or pastiness of the eyelids (especially after a night's sleep) are determined. Also, pyelonephritis is characterized by an increase in blood pressure that is unexplained by other reasons (more than diastolic, or “renal”).

  Unlike adults, children are characterized by a more pronounced manifestation of intoxication disorders, as well as the development of abdominal syndrome (intense abdominal pain accompanied by the absence or mild pain in the lumbar region ). Elderly and senile people are characterized by an erased clinical picture of pyelonephritis, the development of atypical clinical symptoms, or the course of the disease with pronounced general manifestations in the absence of local symptoms.

  

  Diagnostics

  There are many different research methods. These include:

  • general and biochemical blood and urine tests;
  • urine analysis according to Zimnitsky and Nechiporenko;
  • urological examination (examination of the prostate gland, cystoscopy);
  • Ultrasound of the kidneys (increase in size, limitation of mobility during breathing, determination of echogenicity of the parenchyma, detection of stones);
  • abdominal radiography;
  • survey and excretory urography (increase in size, blurred contours of the kidneys, deformations, shadows of stones);
  • cystography (records vesiculourethral reflux);
  • CT, MRI of the kidneys.

  The most reliable and common analysis is the study of urine sediment to determine bacteriuria (more than 100,000 in 1 ml) and to determine sensitivity to antibiotics.

  

  Typical indicators for detecting bacteriuria

  Treatment

  In the treatment of pyelonephritis in men, conservative and surgical methods are considered. Conservative methods include drug therapy to improve urine flow.

  The main medicinal methods of treatment are antiseptic and antibacterial agents (selected taking into account the sensitivity of the microflora), infusion-detoxification, anti-inflammatory, and physiotherapy. It is also advisable to prescribe anticoagulants and antiplatelet agents.

  Necessary measures before starting treatment:

  • establishing the type of pathogen, its sensitivity to antibacterial drugs;
  • determination of the degree of activity of the infectious-inflammatory process;
  • exclusion of factors that aggravate the course of pyelonephritis (diabetes mellitus, urinary tract obstruction, developmental abnormalities, etc.);
  • clarification of the state of urodynamics (presence or absence of disturbances in urine release);
  • assessment of the functional state of the kidneys.

  Therapy for chronic pyelonephritis is divided into two stages:

  • treatment of exacerbation;
  • anti-relapse therapy.

  All medications are selected by the doctor depending on the individual indications and condition of the patient.

  Drug therapy

  Antibacterial drugs used to treat pyelonephritis should be characterized by minimal nephrotoxicity, have a wide spectrum of action, pronounced bactericidal properties and be excreted in the urine in high concentrations.

  Types of antibacterial agents:

  • antibiotics (fluoroquinolones, cephalosporins, protected aminoglycosides);
  • 8-hydroxyquinoline derivatives;
  • nitrofurans;
  • sulfonamides;
  • quinolones (derivatives of pipemidic and nalidixic acid);
  • uroantiseptics of plant origin.

  Protected penicillins (sulbactam + ampicillin, clavulanate + amoxicillin) are considered the drugs of choice for empirical therapy. If Pseudomonas aeruginosa is detected, as well as in complicated forms of pyelonephritis, ureidopenicillins (azlocillin, piperacillin) or carboxypenicillins (ticarcillin, carbenicillin) can be prescribed.

  In addition to penicillin drugs, cephalosporins are widely used, which have moderate nephrotoxicity and can accumulate in the kidney parenchyma and urine in high doses.

  2nd generation cephalosporins (Cefuroxime, etc.) are preferred as treatment for uncomplicated forms of pyelonephritis in outpatient practice. For complicated forms of the disease, 3rd generation cephalosporins are recommended for enteral (ceftibuten, cefixime, etc.) and parenteral administration (ceftriaxone, cefotaxime, etc.). For gram-positive cocci, 4th generation cephalosporins (cefepime) are more effective.

  
  

  The drugs of choice for both outpatient and inpatient treatment of pyelonephritis should include 1st generation fluoroquinolones (ciprofloxacin, ofloxacin, pefloxacin), which have low toxicity, are active against a large number of microbial agents of genitourinary infections and are well tolerated by patients.

  Names of 2nd generation fluoroquinolones: Moxifloxacin, Levofloxacin, Sparfloxacin, Lomefloxacin. Complicated and especially severe forms of pyelonephritis are recommended to be treated with reserve medications - carbapenems (Meropenem, Imipenem).

  In addition to antibiotics, other antimicrobial drugs are also used, which are sometimes prescribed in combination with them, and are used as long-term therapy for the purpose of prevention after discontinuation of antibiotics. These include:

  • combined antimicrobial agents (Co-Trimoxazole);
  • 8-hydroxyquinolines (Nitroxoline);
  • nitrofurans (Furazidin, Nitrofurantoin);
  • nalidixic and pipemidic acid.

  Principles of therapy

  After correcting all possible causes of impaired urinary excretion, treatment for pyelonephritis begins.

  Initially, therapy is carried out until the results of a bacteriological study of the culture are obtained and is represented by broad-spectrum antimicrobial agents. Then, after urine culture and antibiotic sensitivity testing, it becomes empirical and is corrected with narrow-acting antimicrobials. During treatment, you must drink at least 1.5 liters of water per day.

  There are first-rank drugs, or drugs of choice, which are defined as optimal, and second-line drugs, or alternative ones.

  Empirical antibiotic therapy for outpatient treatment of patients with mild to moderate exacerbation of chronic pyelonephritis:

  

  In severe and complicated forms of pyelonephritis, immediate hospitalization is recommended. Inpatient treatment of such patients is described in the table:

  Basic drugs

  Reserve drugs

  Amoxicillin/clavulanate - first IV injections 1.0 g / 0.2 g 3 times a day. – 5 days, then in tablets 500 mg / 125 mg 3 times / day. lasting 9 days. Ciprofloxacin IV 200 mg 2 times a day, then orally 250 mg 2 times a day. Ofloxacin IV 200 mg 2 times a day, then orally 200 mg 2 times. /day Levofloxacin IV 500 mg 1 time/day, then orally 500 mg 1 time/day. Pefloxacin IV 400 mg 2 times a day, orally 400 mg 2 times. /day lasting 9 days. Cefotaxime IV or IM 1–2 g 2–3 times/day. Ceftriaxone IV or IM 1–2 g 1 time/day. Ceftazidime IV or IM 1–2 g 2–3 r. /day lasting 14 days

  Imipenem/cilastatin IM 500 mg twice a day /day lasting 14 days. Ticarcillin/clavulanate IV 3.0 g / 0.2 g 3–4 r. /day Gentamicin IV or IM 80 mg 3 times a day. within 14 days

  The duration of therapy with antibacterial agents during the period is 10–21 days. 30 days after the end of treatment, a control urine examination is carried out. If the pathogen persists, a repeat course is recommended taking into account antibacterial sensitivity.

  For pyelonephritis of a solitary kidney, therapy is performed according to generally accepted methods, but there is a need to monitor the nephrotoxicity of drugs (the use of carbapenems, aminoglycosides and first-generation cephalosporins should be excluded).

  Performance criteria

  There are 3 main groups of indicators of the effectiveness of antibiotic therapy:

  Name	Description
  Early (after 48-72 hours)	Clinical symptoms of positive dynamics: reducing the severity of intoxication manifestations; decrease in body temperature; improvement of general well-being; sterility of urine on the 2nd – 3rd day of treatment; normalization of kidney function
  Late (after 14-30 days)	Clinic of persistent positive dynamics: absence of chills within 2 weeks after the end of antibiotic therapy; obtaining negative results of bacteriological examination of urine on the 3rd – 7th day after the end of antibiotic therapy; no recurrence of fever
  Final (after 1-3 months)	Absence of repeated exacerbations of pyelonephritis during the first 12 weeks after treatment with antibacterial drugs

  Blood pressure control

  Difficulties in reducing blood pressure to target values ​​are a characteristic feature of arterial hypertension in chronic pyelonephritis. When choosing antihypertensive therapy, preference should be given to drugs with maximum nephroprotective activity.

  The first on the list of such drugs are ACE inhibitors, the nephroprotective effect of which has a certain dose dependence: is to prevent irreversible disorders of renal function and reduce the incidence of complications, especially cardiovascular ones.

  With a decrease in renal function, homeostasis disorders are considered in the form of disturbances in electrolyte balance, acid-base status, water-salt metabolism, endocrine and immune functions, retention of nitrogenous waste, and hemorrhagic complications. Ultimately, this can lead to the development of end-stage renal failure (ESRD), which is fraught with severe consequences and requires immediate transfer of the patient to hemodialysis or organ transplantation.

  Prevention of progression of PN is aimed at correcting risk factors, treating the underlying disease and developed complications (arterial hypertension, metabolic processes, hemorrhagic disorders, etc.). Nephroprotective treatment is important.

  When pyelonephritis is complicated by chronic renal failure, there are contraindications, so the approach to drug therapy should be carried out with great caution.

  Treatment of the disease against the background of chronic renal failure is described in the table:

  Preventive actions

  After the symptoms of exacerbation of chronic pyelonephritis are relieved, long-term preventive measures are carried out. Long-term, at least six months, use of low doses of ciprofloxacin, ofloxacin or nitrofurantoin is recommended, especially for patients prone to frequent relapses of the disease.

  In the intervals between courses of antibiotics, the following is prescribed:

  • decoctions of herbs (leaves of lingonberry, wild strawberry, bearberry, birch; cranberries, lingonberries, etc.);
  • combined herbal medicines (Canephron, etc.).

  The herbal medicine Urolesan is highly effective, having anti-inflammatory, antiseptic, diuretic, antispasmodic and choleretic effects.

  
  

  Nutrition for chronic pyelonephritis does not differ from the usual diet; restriction of fluid and salt is necessary only in case of complications, such as edema, arterial hypertension, renal failure, etc. An adequate drinking regime is recommended - 1.5–2 liters daily. Patients with chronic pyelonephritis without exacerbation, without a pronounced increase in blood pressure (up to 179/109 mm Hg) and with adequate kidney function, can be prescribed sanatorium-resort treatment in the cities of Mineralnye Vody, Zheleznovodsk, Truskavets, Karlovy Vary, Kislovodsk.

Pyelonephritis is a nonspecific inflammation. To determine which antibiotics to treat, it is necessary to carry out bacterial culture of urine to identify pathogens.

It may take 2 weeks before the sensitivity of bacteria to the pathogen is determined. Until this time, empirical therapy with broad-spectrum drugs is carried out.

Rational schemes are proposed by the World Health Organization. WHO classifies inflammation of the pyelocaliceal system as a group of tubulointerstitial nephritis, which determines the infectious genesis of the disease.

To determine which antibiotics to treat, you need to find out the primary or secondary nature of the disease. The bacterial etiology of the disease determines the acute course. Chronization occurs in secondary forms.

There is no general classification of nosology. The most common gradation according to Studenikin determines primary and secondary, acute and chronic activity. When determining treatment, the stage of the pyelonephritic process (sclerotic, infiltrative) should be identified.

After a thorough diagnosis of the pathology according to the criteria described above, it is possible to determine which antibiotics to treat pyelonephritis.

Treatment of inflammation of the pyelocaliceal system is possible only after identifying pathogenetic, morphological, symptomatic links. You need to choose not only medications, but also the quality of nutrition, diet, and rest regimen.

The need for hospitalization is determined by the patient’s condition, the likelihood of complications, and the risk to human life. Bed rest for 7 days is rational for pain and severe fever.

Diet for pyelonephritis

The diet for inflammation of the pyelocaliceal system is aimed at reducing renal load. Doctors prescribe table No. 5 according to Pevzner for pathology. Prescribed for exacerbation of the chronic form or acute activity of the disease. The essence of diet therapy is to limit salt; fluid intake decreases as kidney function decreases.

The optimal balance of nutritional ingredients, vitamins, and microelements is achieved by alternating protein and plant foods. Spicy, fatty, fried foods should be excluded; extractive and essential oils should be discarded.

The basis of drug treatment is antibiotics. Which medicines to use is determined by the following principles:

1. Bacterial culture of urine to determine antibiotic sensitivity;
2. Empirical treatment with fluoroquinolones for 2 weeks;
3. Assessment of bacteriuria throughout the course of medication;
4. Lack of effect from therapy is assessed as treatment failure;
5. Persistence of bacteriuria – low effectiveness of therapy;
6. Short courses of antibiotics are prescribed for primary urinary tract infections;
7. Long-term therapy is carried out for infection of the upper genitourinary tract;
8. In case of relapse, bacterial culture is required to determine the flora and sensitivity.

The main stages of antibacterial therapy for pyelonephritis:

• Suppression of the inflammatory process;
• Pathogenetic therapy when the inflammatory process subsides;
• Immunocorrection with antioxidant protection after 10 days of treatment with antibacterial agents;
• Anti-relapse treatment of the chronic form.

Pyelonephritis is treated with antibacterial agents in 2 stages. The first is to eliminate the pathogen. Consists of empirical therapy, targeted treatment after obtaining bacterial culture results, and diuretic therapy. Infusion-corrective treatment procedures help cope with additional symptoms. Hemodynamic disorders require additional correction.

Acute pyelonephritis is treated successfully with antibiotics after culture results are obtained. The test allows you to assess the sensitivity of the combined flora. For a doctor, the result of a bacteriological study is important for determining which antibiotics to treat the inflammatory process of the pyelocaliceal system.

Basic antibiotics for the treatment of kidney inflammation

The selection of an antibiotic is carried out according to the following criteria:

• Activity against the main infectious agents;
• No nephrotoxicity;
• High concentration in the affected area;
• Bactericidal;
• Activity in the pathological acid-base balance of the patient’s urine;
• Synergism when prescribing several drugs.

The duration of antibiotic therapy should not be less than 10 days. This period prevents the formation of protective forms of bacteria. Inpatient treatment lasts at least 4 weeks. Approximately every week you need to replace the drug. To prevent repeated relapses of the disease, nephrologists recommend combining antibiotics with uroseptics. The drugs prevent recurrent exacerbations.

Empirical treatment of pyelonephritis: starting antibiotics

Starting antibacterial drugs for pyelonephritis:

1. A combination of beta-lactamase inhibitors with semisynthetic penicillins (amoxicillin when combined with clavulanic acid) - Augmentin in a daily dose of 25-50 mcg, amoxiclav - up to 49 mcg per kilogram of body weight per day;
2. 2nd generation cephalosporins: cefamandole 100 mcg per kilogram, cefuroxime;
3. 3rd generation cephalosporins: ceftazidime 80-200 mg, cefoperazone, ceftriaxone intravenously 100 mg;
4. Aminoglycosides: gentamicin sulfate – 3-6 mg intravenously, amikacin – 30 mg intravenously.

Antibacterial drugs when the activity of the inflammatory process subsides:

• 2nd generation cephalosporins: Vercef, Ceclor 30-40 mg;
• Semi-synthetic penicillins in combination with beta-lactamases (augmentin);
• 3rd generation cephalosporins: Cedex 9 mg per kilogram;
• Nitrofuran derivatives: furadonin 7 mg;
• Quinolone derivatives: nalidixic acid (nevigramon), nitroxoline (5-nitrox), pipemidic acid (pimidel) 0.5 grams per day;
• Trimethoprim, sulfamethoxazole – 5-6 mg per kilogram of weight.

Severe septic form of pyelonephritis with the presence of multi-resistance of the flora to antibacterial drugs requires a long period of medication. Proper treatment also includes bactericidal and bacteriostatic drugs. Combination therapy is carried out for a month for acute and chronic forms of the disease.

Bactericidal drugs for inflammation of the kidney calyces:

1. Polymyxins;
2. Aminoglycosides;
3. Cephalosporins;
4. Penicillins.

Bacteriostatic agents:

1. Lincomycin;
2. Chloramphenicol;
3. Tetracyclines;
4. Macrolides.

When choosing treatment tactics for a disease, it is necessary to take into account the synergism of drugs. The most optimal combinations of antibiotics: aminoglycosides and cephalosporins, penicillins and cephalosporins, penicillins and aminoglycosides.

Antagonistic relationships have been identified between the following drugs: chloramphenicol and macrolides, tetracyclines and penicillins, chloramphenicol and penicillins.

The following drugs are considered low-toxic and nephrotoxic: tetracycline, gentamicin, cephalosporins, penicillins, polymyxin, monomycin, kanamycin.

Aminoglycosides should not be used for more than 11 days. After this period, their toxicity increases significantly when the drug concentration in the blood reaches more than 10 mcg per milliliter. When combining drugs with cephalosporins, a high creatinine content is achieved.

To reduce toxicity after a course of antibiotic therapy, it is advisable to carry out additional treatment with uroantiseptics. Nalidixic acid preparations (blacks) are prescribed to children over 2 years of age. The drugs have a bactericidal and bacteriostatic effect on gram-negative flora. These antiseptics cannot be used together with nitrofurans for more than 10 days.

Gramurin has a wide spectrum of antibacterial action. The oxolinic acid derivative is prescribed for 10 days.

Pimidel has a positive effect on most gram-negative bacteria. Suppresses the activity of staphylococci. Treatment with the drug is carried out in a short course lasting 7-10 days.

Nitrofurans and nitroxoline have a bactericidal effect. Medicines have a wide range of effects on bacteria.

The backup agent is zanocin. The wide spectrum of action of the drug on the intracellular flora allows the drug to be used when the effect of other uroseptics is low. The impossibility of prescribing the drug as the main therapeutic agent is due to its high toxicity.

Biseptol is a good anti-relapse medicine for pyelonephritis. It is used for long-term inflammation of the pyelocaliceal system.

What diuretics are used to treat pyelonephritis?

In addition to antibiotics, pyelonephritis is treated with fast-acting diuretics in the first days. Veroshpiron, furosemide are drugs that help increase the activity of renal blood flow. The mechanism is aimed at removing microorganisms and inflammatory products from the edematous tissue of the pelvis. The volume of infusion therapy depends on the severity of intoxication, urine output, and the patient’s condition.

Pathogenetic treatment is prescribed for microbial inflammatory processes during antibiotic therapy. The duration of therapy is no more than 7 days. When combining treatment with antisclerotic, immunocorrective, antioxidant, anti-inflammatory therapy, you can count on complete eradication of microorganisms.

Surgam, Voltaren, and Ortofen are taken for 14 days. Indomethacin is contraindicated in children. To prevent the negative effect of the anti-inflammatory drug indomethacin on the child’s gastrointestinal tract, it is not recommended to use the drugs for more than 10 days. To improve blood supply to the kidneys, increase filtration, and restore the balance of electrolytes and water, drinking plenty of fluids is recommended.

Desensitizing drugs (claritin, suprastin, tavegil) are used for chronic or acute pyelonephritis. Relief of allergic reactions and prevention of sensitization is carried out with the help of tocopherol acetate, unithiol, beta-carotene, trental, cinnarizine, aminophylline.

Immunocorrective therapy is prescribed for the following indications:

• Serious kidney damage (multiple organ failure, obstructive pyelonephritis, purulent inflammation, hydronephrosis, megaureter);
• Infancy;
• The duration of inflammation is more than a month;
• Antibiotic intolerance;
• Mixed microflora or mixed infection.

Immunocorrection is prescribed only after consultation with an immunologist.

Chronic pyelonephritis, what immunotropics to treat:

1. Lysozyme;
2. Myelopid;
3. Cycloferon;
4. Viferon;
5. Leukinferon;
6. Reaferon;
7. Imunofan;
8. Lycopid;
9. Levamisole;
10. T-activin.

If a patient has a secondary wrinkled kidney, drugs with an antisclerotic effect lasting more than 6 weeks (Delagil) should be used.

Against the background of remission, herbal infusions (chamomile, rose hips, yarrow, birch buds, bearberry, lovage, corn silk, nettle) are prescribed.

Antibiotics are prescribed at the stage of anti-relapse therapy for about a year with periodic breaks.

The diet is combined with all the stages described above. In the acute form, it is important to adhere to bed rest for a week.

Anti-relapse drugs are prescribed on an outpatient basis. Biseptol is prescribed at a dose of 2 mg per kilogram, sulfamethoxazole – once a day for 4 weeks. Furagin at the rate of 8 mg per kilogram of weight for a week. Treatment with pipemidic or nalidixic acid is carried out for 5-8 weeks. The backup regimen involves the use of biseptol or nitroxoline in a dosage of two to 10 mg. For the treatment of recurrent forms, nitroxoline can be used in the morning and evening in a similar dose.

When assessing which antibiotics to treat pyelonephritis, many factors that arise during inflammation of the renal collecting system should be taken into account.

Pyelonephritis is one of the most common nephrological diseases that affects the kidney parenchyma and renal pelvis. One of the serious consequences of pyelonephritis with improper or untimely treatment is the transition of the disease from acute to chronic form, which is very difficult to treat.

Therapy

Treatment of pyelonephritis is primarily aimed at alleviating the patient’s condition and relieving the first symptoms. The next important goal of therapy is to eliminate the cause of the disease.

Antibacterial therapy is the main method of treatment, since in most cases, kidney inflammation is caused by one or another bacteria. To eliminate the infection, the patient is prescribed antimicrobial drugs, including antibiotics. Antipyretics and drugs with analgesic and antispasmodic effects help relieve symptoms.

In the complex treatment of pyelonephritis, plant-based drugs are also used. These include Fitolysin paste, Canephron N tablets and other medicines that contain horsetail herbs, birch leaf extract, bearberry, etc.

Antimicrobials

This group of drugs consists of synthetic compounds of the following chemical classes:

• nitrofurans;
• fluoroquinolones;
• sulfonamides;
• hydroxyquinolines;
• phosphonic acid derivatives.

Nitrofurans

Nitrofurans include drugs such as Furamag (Furazidin), Furadonin (Nitrofurantoin), etc. The active substances of the tablets fight Trichomonas, Giardia and gram-negative bacteria. Typically, these drugs treat chronic pyelonephritis. The drugs are contraindicated in children under 1 month of age and during pregnancy and lactation. The tablets should not be taken by people with hepatitis, kidney failure, or hypersensitivity to the components of the drug. In rare cases, they cause adverse reactions: nausea, headache, vomiting, allergies, anorexia.

Fluoroquinolones

These are second generation drugs. They are known for their bactericidal effect. The drugs kill gram-positive bacteria (pneumococci), anaerobes and intracellular pathogens. To treat kidney inflammation, in particular pyelonephritis, the following medications are prescribed:

1. Norfloxacin. The drug is prescribed by a doctor for acute and chronic urinary tract infections that are caused by pathogens with high sensitivity to the drug. The tablets are contraindicated for women during pregnancy and breastfeeding, people with liver failure and those with individual intolerance to the components of the drug. It is not recommended to take Norfloxacin for children aged 7-13 years, epileptics and patients with severe renal impairment. The medicine may cause side effects, the most common being lack of appetite, headache, diarrhea, drowsiness, and fatigue.
2. Ciprofloxacin (Ciprinol). This drug is several times more active than Norfloxacin. The tablets are highly effective against urinary tract infections. The medicine is contraindicated for children under 15 years of age, pregnant and lactating women, people with individual intolerance to the drug components, and epileptics. The tablets are prescribed with caution to patients with kidney disease. The drug is usually well tolerated by patients. In rare cases, there may be diarrhea, vomiting, nausea, anxiety, facial swelling, headache, lack of appetite, impaired perception of taste and smell.
3. Ofloxacin. Effectively destroys gram-negative pathogens. The tablets help with pyelonephritis and other infectious diseases of the kidneys, urinary tract, and abdominal cavity. The medicine is contraindicated during pregnancy and lactation, children under 15 years of age, epileptics, and patients with high sensitivity to quinolones.

Sulfonamides

They effectively fight chlamydia, gram-negative bacteria. For pyelonephritis, which is caused by Pseudomonas aeruginosa, enterococcus or anaerobes, these drugs are powerless. The following medications are most often prescribed for treatment:

1. Biseptol. The drug prevents the proliferation of bacteria and provides high bactericidal activity against gram-positive and gram-negative pathogens. Tablets should not be taken during pregnancy, in patients with impaired kidney and liver function, with diseases of the hematopoietic system and with high sensitivity to the components of the drug. Taking the drug may cause diarrhea, vomiting, nausea, and allergic reactions. When treating with Biseptol, you need to monitor your blood picture. Today it is considered ineffective.
2. Urosulfan. The tablets are especially active against E. coli and staphylococci. The drug is prescribed for acute and chronic pyelonephritis, infectious diseases of the urinary tract. The drug is contraindicated in patients with hypersensitivity to sulfonamides.

Hydroxyquinolines

The most popular drug is Nitroxoline. The tablets destroy gram-negative and gram-positive bacteria. This medicine treats pyelonephritis, urethritis, cystitis and other infectious diseases of the kidneys and genitourinary tract. They are beginning to abandon it due to its low effectiveness due to the high resistance of bacteria. The drug is usually well tolerated by patients, in rare cases an allergic reaction and nausea are observed; people with liver failure take the tablets with caution. In case of hypersensitivity to the components of the drug, the medicine is contraindicated.

Phosphonic acid derivatives

Monural tablets are the only representative of the group of antimicrobial drugs. The medicine has a wide spectrum of action - the active substance in its composition (fosfomycin) effectively fights most gram-positive microorganisms. The drug is prescribed for infectious diseases of the urinary tract, bacterial urethritis and cystitis, and also as a prophylactic against infections in the postoperative period. The tablets are allowed to be used during pregnancy. Monural treats massive bacteriuria in pregnant women. The medicine is contraindicated in children under 5 years of age, women during lactation, people with renal failure and hypersensitivity to fosfomycin. The drug sometimes causes nausea, diarrhea, heartburn, and skin rash.

Penicillins

Penicillin antibiotics for pyelonephritis have been used for a long time and successfully. For inflammation of the tissues of the renal pelvis and kidneys, Amoxiclav is most often prescribed. This antibacterial combination drug is contraindicated in patients with hepatitis and people with individual intolerance to the active substances - amoxicillin and clavulanic acid. Side effects include diarrhea, nausea, urticaria, thrombocytopenia, anemia, candidiasis, etc. Treating pyelonephritis during pregnancy and lactation is allowed, but only under the strict supervision of a doctor.

Cephalosporins

Often during illness, doctors prescribe injectable cephalosporin antibiotics, the most common being Cefazolin. This antimicrobial drug is prescribed for the treatment of acute pyelonephritis and other infectious diseases; it is administered to the patient intravenously or intramuscularly. Injections are contraindicated for pregnant women, children under 1 month of age and patients with hypersensitivity to the components of the antibiotic. Itching and allergic skin reactions may occur.

Pyelonephritis is a severe infectious disease that can be caused by various pathogenic microorganisms. Determining the specific pathogen and selecting antibacterial therapy is the main method of treating this pathology. The cause of the development of the disease is often a violation of the passage of urine, nephrolithiasis and other abnormalities in the functioning of the urinary system.

In this regard, treatment of pyelonephritis must also necessarily include measures to eliminate the etiological factor to prevent future relapses of inflammatory processes in the kidneys. The therapeutic methods used are selected taking into account the severity of the disease, the nature of the course, the presence of complications, as well as the characteristics of the patient’s health condition. In acute forms of pyelonephritis or exacerbations of the chronic form, treatment should be carried out under the strict supervision of specialists.

Treatment of acute pyelonephritis

Acute pyelonephritis is a serous or purulent inflammation with predominant damage to the renal interstitial tissue. In most cases, the disease develops in only one kidney. The acute course of the disease is characterized by the sudden appearance of severe symptoms such as chills, fever, high temperature, weakness, etc. To avoid consequences, treatment of pyelonephritis should begin immediately and include a set of measures, including taking antibiotics and other drugs, following a diet and bed rest. If necessary, surgical intervention is also used to eliminate the cause of the disease.

Drug therapy

How to treat pyelonephritis and what medications to take? Treatment of acute pyelonephritis is recommended in a hospital setting. In the first days, strict bed rest and warmth are indicated. The selection of drug therapy is carried out taking into account the data of bacteriological urine culture, the presence or absence of urinary tract obstruction, the functional state of the kidneys and the severity of inflammation. If the patient has a disturbance in the normal outflow of urine, then first of all measures are taken to restore it.

The main drugs used to treat pyelonephritis are antibiotics. A course of antibacterial therapy to completely destroy pathogenic microorganisms and prevent relapses or transition of the disease to a chronic form is recommended for at least 6 weeks. In the first days, patients are usually prescribed injectable dosage forms, and then transferred to tablet forms. Given that urine bacterial culture may take several days, a broad-spectrum antibiotic is first empirically selected and then, based on the results, the drug is changed if necessary. For pyelonephritis, depending on the specific pathogen, the following groups of antibacterial agents are used:

• penicillins;
• sulfonamides;
• cephalosporins;
• fluoroquinolones;
• pipemidic acid derivatives;
• nalidixic acid derivatives;
• nitrofuans.

Antibacterial drugs are widely used to treat acute pyelonephritis.

The main requirements for antibiotics for the treatment of pyelonephritis are:

• high bactericidal activity;
• minimal nephrotoxicity;
• maximum degree of elimination in urine.

The criterion for the effectiveness of antibiotic therapy is the reduction of symptoms, intoxication, improvement of kidney function and the general condition of the patient 2-3 days after the start of treatment. At the end of taking antibiotics, a repeat general and bacteriological urine test is performed to monitor the effectiveness of the prescribed therapy. Additionally, instrumental research methods can be used to assess the condition of the urinary system: excretory urography, ultrasound, cytoscopy, etc.

Important: If symptoms of acute kidney inflammation appear, the patient must submit urine for bacteriological examination. Identifying pathogenic microorganisms and determining their sensitivity to antibiotics will allow you to choose the right treatment.

If the cause of the development of pyelonephritis is some kind of kidney disease or other organs of the urinary system, then the underlying disease must also be treated.

Diet

Proper nutrition during acute pyelonephritis helps the body cope with the infection and reduces the load on the kidneys. In addition, drinking plenty of fluids is recommended. Cranberry and lingonberry fruit drinks or rosehip decoction, which have anti-inflammatory and diuretic effects, will be especially useful. Freshly squeezed vegetable or fruit juices are a valuable source of additional vitamins needed by the body during illness. You are allowed to drink mineral water, compotes, green and herbal teas.

To reduce intoxication in acute pyelonephritis, drinking plenty of fluids is indicated

In acute form of pyelonephritis, you must adhere to the following dietary rules:

• completely eliminate marinades, canned food, spices, and smoked foods;
• limit the consumption of baked goods and sweets;
• exclude alcohol, carbonated water, strong black tea and coffee;
• do not eat fried, fatty, spicy and peppery foods containing pepper, horseradish, garlic;
• exclude difficult-to-digest foods (mushrooms, legumes, etc.);
• increase the amount of foods that have a diuretic effect (melons, watermelons, apples, zucchini, etc.).

The basis of the diet should initially be fruits and vegetables; after acute inflammation has been relieved, boiled lean meat and dairy products can be introduced.

Advice: If kidney inflammation is accompanied by increased blood pressure, it is recommended to significantly limit or completely eliminate salt intake.

Surgery

Surgical treatment of pyelonephritis is carried out in case of severe purulent kidney damage, which is characterized by the formation of carbuncles and apostemes, in case of ineffectiveness of antibacterial therapy and other conservative methods. The purpose of surgical intervention is to stop further progression of the inflammatory process, prevent its spread to a healthy kidney, and remove obstacles to the normal outflow of urine in case of obstruction. In this case, the organ is decapsulated, drained, and the ulcers are opened. If the organ is completely damaged (purulent-destructive stage), surgery is performed to remove the kidney.

Treatment of chronic pyelonephritis

In approximately 20% of patients, acute pyelonephritis becomes chronic, the course of which is characterized by alternating periods of remission and exacerbations. In case of exacerbation, the same therapeutic methods are used as for acute kidney inflammation. During the period of remission, treatment of chronic pyelonephritis is carried out at home under clinical supervision. At this time, it is necessary to follow a diet, drink decoctions of medicinal herbs and, if possible, undergo recovery in a specialized sanatorium. Once every three months, such patients must visit a doctor, undergo examination and tests.

• avoid hypothermia;
• adhere to the correct drinking regime;
• take measures to prevent colds and infectious diseases;
• strengthen immunity;
• follow a diet;
• empty your bladder regularly (every 3-4 hours);
• take prophylactic short courses of antibacterial drugs (in consultation with your doctor);
• observe the rules of intimate hygiene.

In patients with chronic pyelonephritis, hypothermia is fraught with exacerbation of the disease

Advice: If symptoms of exacerbation of chronic pyelonephritis appear, you should immediately consult a doctor.

Traditional methods of treatment

For pyelonephritis, treatment with folk remedies can be used as an additional method of therapy both during exacerbations and during remission. For this purpose, medicinal herbs that have anti-inflammatory, bactericidal, antiseptic and diuretic effects are used individually or as part of collections in the form of decoctions or infusions. The combined use of folk and traditional methods of treating pyelonephritis helps speed up the patient's recovery during exacerbation of the disease. Among the folk remedies used for medicinal purposes for kidney inflammation, the most effective are:

• juice from knotweed leaves;
• propolis oil;
• a decoction of a mixture of bearberry leaves, calamus flaxseed, kidney tea, licorice root, birch buds;
• oat decoction with milk or water;
• infusion of lingonberry leaves, blue cornflower flowers, birch leaves;
• a decoction of aspen bark, bearberry, and Siberian elderberry leaves.

Folk remedies for pyelonephritis are used as part of complex treatment

Important: Before starting to use folk remedies for the treatment of pyelonephritis, you should consult a doctor, as some plants may have contraindications.

But perhaps it would be more correct to treat not the effect, but the cause?

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Pyelonephritis

is an acute or chronic kidney disease that develops as a result of exposure to certain causes (factors) on the kidney that lead to inflammation of one of its structures, called the collecting system (the structure of the kidney in which urine accumulates and is excreted) and adjacent to it structure, tissue (parenchyma), with subsequent dysfunction of the affected kidney.

The definition of “Pyelonephritis” comes from the Greek words (pyelos - translated as pelvis, and nephros - kidney). Inflammation of the kidney structures occurs in turn or simultaneously, it depends on the cause of pyelonephritis, it can be unilateral or bilateral. Acute pyelonephritis appears suddenly, with severe symptoms (pain in the lumbar region, fever up to 390C, nausea, vomiting, difficulty urinating), with proper treatment after 10-20 days, the patient fully recovers.

Chronic pyelonephritis is characterized by exacerbations (most often in the cold season) and remissions (symptoms subside). Its symptoms are mild, most often it develops as a complication of acute pyelonephritis. Often chronic pyelonephritis is associated with any other disease of the urinary system (chronic cystitis, urolithiasis, abnormalities of the urinary system, prostate adenoma and others).

Women, especially young and middle-aged women, get the disease more often than men, approximately in a ratio of 6:1, this is due to the anatomical features of the genital organs, the onset of sexual activity, and pregnancy. Men more often develop pyelonephritis at an older age; this is most often associated with the presence of prostate adenoma. Children also get sick, more often at an early age (up to 5-7 years), compared to older children, this is due to the body’s low resistance to various infections.

Kidney anatomy The kidney is an organ of the urinary system that is involved in removing excess water from the blood and products released by body tissues that are formed as a result of metabolism (urea, creatinine, medications, toxic substances, and others). The kidneys remove urine from the body, then through the urinary tract (ureters, bladder, urethra), it is released into the environment.

The kidney is a paired organ, bean-shaped, dark brown in color, located in the lumbar region, on either side of the spine.

The weight of one kidney is 120 - 200 g. The tissue of each kidney consists of the medulla (in the shape of pyramids), located in the center, and the cortex, located along the periphery of the kidney. The tops of the pyramids merge in 2-3 pieces, forming renal papillae, which are covered by funnel-shaped formations (small renal calyces, on average 8-9 pieces), which in turn merge in 2-3 pieces, forming large renal calyces (on average 2-4 in one kidney). Subsequently, the large renal calyces pass into one large renal pelvis (a funnel-shaped cavity in the kidney), which in turn passes into the next organ of the urinary system, called the ureter. From the ureter, urine flows into the bladder (a reservoir for collecting urine), and from it through the urethra to the outside.

Inflammatory processes in the calyces and pelvis of the kidney are called pyelonephritis. Causes and risk factors in the development of pyelonephritis

Symptoms of pyelonephritis

1. Aching, constant pain in the lumbar region, dull in nature, unilateral or bilateral (depending on how many kidneys are affected), sometimes accompanied by attacks called renal colic (in the presence of stones in the urinary tract), in children, unlike adults, such pain occurs in the abdomen;
2. Symptoms of body intoxication, are more often characteristic of acute pyelonephritis (increased body temperature up to 380C, nausea, possibly vomiting, loss of appetite, chills, sweating), its development is the result of the entry of infectious toxins into the blood and their negative impact on tissues;
3. Urinary dysfunction

• burning and pain during urination, due to inflammation in the urinary tract;
• the need to urinate more frequently than usual, in small portions;
• beer-colored urine (dark and cloudy) is the result of the presence of a large number of bacteria in the urine,
• unpleasant smell of urine,
• often the presence of blood in the urine (stagnation of blood in the vessels, and the release of red blood cells from the vessels into the surrounding inflamed tissues).

1. Pasternatsky's symptom is positive - when a light blow is applied to the lumbar region with the edge of the palm, pain appears.
2. Swelling, formed in the chronic form of pyelonephritis, in advanced cases (lack of treatment), often appears on the face (under the eyes), legs, or other parts of the body. Swelling appears in the morning, soft, dough-like consistency, symmetrical (the left and right sides of the body are the same size).

Diagnosis of pyelonephritis General urine analysis- indicates deviations in the composition of urine, but does not confirm the diagnosis of pyelonephritis, since any of the deviations may be present in other kidney diseases.
Correct urine collection:

In the morning, the external genital organs are toileted, only after this the morning, first portion of urine is collected in a clean, dry container (a special plastic cup with a lid). Collected urine can be stored for no more than 1.5-2 hours.

Indicators of general urine analysis for pyelonephritis:

• High level of leukocytes (normally in men there are 0-3 leukocytes in the field of view, in women up to 0-6);
• Bacteria in urine >100,000 per ml; the excreted urine is normal and must be sterile, but when collecting it, hygienic conditions are often not observed, so the presence of bacteria up to 100,000 is allowed;
• Urine density
• Urine pH is alkaline (normally acidic);
• The presence of protein, glucose (normally they are absent).

Urine analysis according to Nicheporenko:

• Leukocytes are elevated (normally up to 2000/ml);
• Red blood cells are elevated (normally up to 1000/ml);
• Presence of cylinders (normally they are absent).

Bacteriological examination of urine: used when there is no effect from the accepted course of antibiotic treatment. A urine culture is performed to identify the causative agent of pyelonephritis, and in order to select an antibiotic sensitive to this flora for effective treatment.

Kidney ultrasound: is the most reliable method for determining the presence of pyelonephritis. Determines different sizes of kidneys, a decrease in the size of the affected kidney, deformation of the collecting system, identification of a stone or tumor if present.

Excretory urography, is also a reliable method for detecting pyelonephritis, but compared to ultrasound, it is possible to visualize the urinary tract (ureter, bladder), and if there is a blockage (stone, tumor), determine its level.

CT scan, is the method of choice, using this method you can assess the degree of damage to the kidney tissue and identify if complications are present (for example, the spread of the inflammatory process to neighboring organs)

Treatment of pyelonephritis Drug treatment of pyelonephritis

1. Antibiotics, are prescribed for pyelonephritis; based on the results of a bacteriological examination of urine, the causative agent of pyelonephritis is determined and which antibiotic is sensitive (suitable) against this pathogen.

Antibiotics and antiseptics in the treatment of pyelonephritis:

• Penicillins (Amoxicillin, Augmentin). Amoxicillin orally, 0.5 g 3 times a day;
• Cephalosporins (Cefuroxime, Ceftriaxone). Ceftriaxone intramuscularly or intravenously, 0.5-1 g 1-2 times a day;
• Aminoglycosides (Gentamicin, Tobramycin). Gentamicin intramuscularly or intravenously, 2 mg/kg 2 times a day;
• Tetracyclines (Doxycycline, 0.1 g orally 2 times a day);
• Levomycetin group (Chloramphenicol, 0.5 g orally 4 times a day).

• Sulfonamides (Urosulfan, 1 g orally 4 times a day);
• Nitrofurans (Furagin, orally 0.2 g 3 times a day);
• Quinolones (Nitroxoline, 0.1 g orally 4 times a day).

1. Diuretics: prescribed for chronic pyelonephritis (to remove excess water from the body and possible edema), and not prescribed for acute pyelonephritis. Furosemide 1 tablet 1 time per week.
2. Immunomodulators: increase the body's reactivity in case of illness, and to prevent exacerbation of chronic pyelonephritis.

• Timalin, intramuscularly 10-20 mg once a day, 5 days;
• T-activin, intramuscularly 100 mcg once a day, 5 days;

1. Multivitamins, (Duovit, 1 tablet 1 time a day), Ginseng tincture - 30 drops 3 times a day, are also used to increase immunity.
2. Nonsteroidal anti-inflammatory drugs(Voltaren), have an anti-inflammatory effect. Voltaren orally, 0.25 g 3 times a day, after meals.
3. To improve renal blood flow, these drugs are prescribed for chronic pyelonephritis. Curantil, 0.025 g 3 times a day.

Herbal medicine for pyelonephritis

Herbal medicine for pyelonephritis is used as an addition to drug treatment, or to prevent exacerbation of chronic pyelonephritis, and is best used under the supervision of a physician.

Cranberry juice has an antimicrobial effect, drink 1 glass 3 times a day.

Bearberry decoction has an antimicrobial effect, take 2 tablespoons 5 times a day.

Boil 200 g of oats in one liter of milk, drink ¼ glass 3 times a day.

Kidney collection No. 1: A decoction of a mixture (rose hips, birch leaves, yarrow, chicory root, hops), drink 100 ml 3 times a day, 20-30 minutes before meals.

It has a diuretic and antimicrobial effect.

Collection No. 2: bearberry, birch, hernia, knotweed, fennel, calendula, chamomile, mint, lingonberry. Finely chop all these herbs, add 2 tablespoons of water and boil for 20 minutes, take half a glass 4 times a day.

How are kidney pyelonephritis treated?

Pyelonephritis is a serious disease that, in the absence of help and effective treatment, leads to the development of severe complications.

How to treat pyelonephritis depends on the form of the disease. Properly selected medications help speed up the process of complete recovery for the patient.

Description of the pathology

Pyelonephritis is a disease characterized by inflammation of the tubules and parenchyma of the kidneys caused by pathogenic microorganisms.

According to statistics, pyelonephritis is diagnosed in women much more often than in men, which is associated with a number of anatomical and physiological features of the urinary system.

The classification of bacterial inflammation is based on the nature of the course and the causes of its occurrence. The clinical picture and treatment regimen depend on this.

Acute primary develops as an independent disease associated with kidney infection. This variety is common.

Acute secondary - the result of the progression of other diseases of bacterial origin.

This pathology is considered a complication and manifests itself in various diseases. First of all, the risk of developing secondary pyelonephritis is high in septic conditions.

The chronic form of the pathology becomes the result of lack of treatment or inadequate drug therapy for.

Sometimes it occurs in patients in whom acute pyelonephritis was asymptomatic. Such cases are extremely rare, since this disease is characterized by a clear manifestation of the clinical picture.

The classification identifies several forms of the disease, which is associated with the type of inflammatory process. Serous pyelonephritis occurs easily, the danger is the necrotic form and kidney abscess.

With timely initiation of treatment, the prognosis for the outcome of the disease is favorable. For this reason, it is better not to delay, but to immediately call a doctor when the first symptoms appear.

Treatment of the disease

• elimination of bacteria in the urinary tract;
• prevention of sclerotic changes in the structure of the kidneys;
• normalization of the process of urine production.

For this purpose, drugs are used in various forms of release, ranging from tablets to intravenous infusions.

The main groups of drugs used for treatment are:

• non-steroidal anti-inflammatory drugs;
• diuretics;
• antispasmodics;
• sulfonamides;
• nitrofuran derivatives.

The choice of groups of drugs depends on the severity of the patient’s condition, the severity of symptoms, and the characteristics of the course of the disease.

More often, the treatment regimen includes the use of antibacterial, antispasmodic and anti-inflammatory drugs.

Treatment with drugs with an antibacterial effect for pyelonephritis is the main one.

For pyelonephritis, the effectiveness of a combination of nitrofurans with sulfonamide drugs is noted.

In some cases, complex treatment regimens are used, in which several antibiotics and nitrofurans are used.

Tablets for pyelonephritis are rarely prescribed. In most patients, intramuscular administration of drugs is indicated.

Parenteral drugs help achieve the required concentration of the active substance in the bloodstream.

In some cases, when the disease progresses and the bacterial process is pronounced, antibiotics are administered intravenously.

The indication for such administration of drugs is the onset of the development of septic complications.

Anti-inflammatory drugs and antispasmodics

Often with pyelonephritis, there is an increase in the volume of the affected kidney, a violation of the outflow of urine, which is associated with a violation of the patency of the ureters.

Such processes develop due to the fact that the smooth muscles of the ureters spasm, resulting in a decrease in the lumen.

The use of antispasmodics is necessary because stagnation of urine in the kidneys stimulates the formation of stones and sand. That is, pyelonephritis ends with the development of urolithiasis.

To eliminate spasms, patients are prescribed Papaverine, Drotaverine or commercial analogues. It is necessary to carefully approach the choice of dosage and take into account contraindications.

Anti-inflammatory drugs are used in the treatment regimen to speed up the recovery of the affected organ and prevent the proliferation of connective tissue.

Representatives of this group of drugs are Diclofenac and derivatives. Prescribed in tablet form, and in rectal or rectal form.

The latter option is safer, since the negative effect on the mucous membrane of the stomach and duodenum is eliminated.

Diuretics

Diuretics are prescribed when the patient has a normal urine outflow process and daily diuresis is not lower than 80%.

Daily diuresis is the relationship between the amount of fluid consumed and the amount of urine. A decrease in this indicator indicates kidney dysfunction and the development of edema.

Most often, patients are prescribed Mannitol or Furosemide. These medications are taken in tablet form.

The use of diuretics is combined with an increase in the amount of fluid consumed. To prevent dehydration and water-electrolyte imbalance.

In such a situation, diuretics cause the disease to enter the stage of decompensation, which is fraught with anuria or uremic coma.

Herbal remedies

Preparations from herbal components that are used for auxiliary therapy for pathologies of the urinary system. Best suited for the treatment of cystitis and pyelonephritis.

Well-known drugs in this group are Urolesan and Canephron. These drugs have weak antibacterial, diuretic and anti-inflammatory effects.

The advantage of the drugs is that they are used even during pregnancy and breastfeeding, which is extremely important. During pregnancy, pyelonephritis often appears in women.

These medications are not suitable for complete treatment. Be sure to combine with antibiotics and other means of etiotropic therapy.

"Urolesan" and "Canephron" are well suited as a prophylactic agent for chronic pyelonephritis - to prevent exacerbations.

Auxiliary treatment

In addition to the fact that treatment of pyelonephritis requires the use of medications, they are supplemented with diet, regimen,.

The last rule plays an important role, since an acidic environment stimulates the growth of bacteria and the formation of stones and sand.

Physiotherapy is more often used during recovery. Electrophoresis and heating using installations help improve blood flow in the affected organs, which accelerates the elimination of metabolites and dead bacteria accumulated in the kidneys.

It should not be used in the acute phase of the disease, as this leads to the formation of a kidney abscess.

Complete treatment of pyelonephritis is possible only if the patient follows the treatment regimen prescribed by the doctor and follows the recommendations regarding the daily routine.

Video

Inflammation of the kidneys, called pyelonephritis, is a very common pathology in women. It occurs with almost the same frequency as cystitis. Untimely treatment of bladder disease is a common cause of ascending infection.

Men suffer from this disease less. This difference is explained by anatomical features. Through a short urethra, microorganisms more easily penetrate into the excretory system. Not only adults are susceptible to pathology; this disease often occurs in children as well. Modern pharmacology produces tablets for pyelonephritis of various compositions and directions, which can effectively cope with the problem.

Medicine for pyelonephritis should be selected by a doctor. Be sure to start therapy with antibiotics. This will help localize the process and prevent the development of complications that can cause irreparable damage to human health.

The best therapeutic response comes from complex treatment. This makes the patient's condition easier. Medicines are prescribed in the form of droppers, intramuscular injections, intravenous infusions, and tablets. It is possible to use anesthetic gels on the lumbar area, which have a local anesthetic and warming effect.

Causes of the inflammatory process

The occurrence of pyelonephritis in women occurs most often as a result of the ascending spread of infection. The hematogenous route is also possible. The causative agents may be:

• enterococci;
• intestinal proteus;
• Pseudomonas aeruginosa;
• staphylococcus

They penetrate from the rectum into the bladder. Further spread occurs to the kidneys.

It is important to know! The disease is promoted by low immunity, failure to comply with hygiene rules both by the woman herself and her sexual partner, hypothermia, overwork, stress, congestion in the pelvic organs, impaired urine outflow, and sexually transmitted infections. With the movement of blood, microorganisms can penetrate from other foci of inflammation (descending method).

Symptoms of acute and chronic forms

Pyelonephritis can manifest itself with various signs. They appear depending on the form of the disease that caused it. The most characteristic of them are:

• discomfort, heaviness in the lumbar region;
• frequent urination;
• weakness, fatigue;
• high body temperature;
• hypertension;
• swelling of the face and limbs;
• headache;
• nausea.

The following symptoms are more pronounced in an acute process: high levels of hyperthermia, severe pain in the kidney area. The chronic form does not give such a clear picture; in the remission stage, the patient may not be bothered by anything or the discomfort is insignificant.

Complications of pyelonephritis in women

The most dangerous complication of the disease is the suppurative process. Pathology occurs as a consequence of an advanced condition, in the absence of timely treatment. Manifests itself in the form of an abscess, renal carbuncle, apostematous nephritis (many small ulcers). These pathologies pose a threat of loss of the patient’s organ, and there is a high risk of death.

Advice! Neglecting doctor's prescriptions or interrupting the course of medication impairs the functional ability of the paired organ. It is possible to develop renal failure, which is very dangerous for a woman’s life and requires further hemodialysis procedures and a kidney transplant.

Dr. Elena Malysheva believes that the greatest danger comes from the asymptomatic course of the disease, when the patient experiences only general weakness, attributing it to overwork. Also, the symptoms of an acute process are often perceived as signs of a cold, and only the addition of severe pain forces one to seek medical help.

Diagnostics for choosing the right drug

For successful treatment of pyelonephritis and selection of the most effective drugs from the list for a particular patient, it is important to diagnose the disease. To do this, after an initial examination and history taking, the doctor prescribes a number of examinations.

These include:

With vague manifestations, an important condition is to differentiate with other diseases that have similar symptoms.

Features of drug therapy in women

Pyelonephritis detected in a woman requires treatment to be prescribed immediately; only a doctor should select drugs and doses. The disease can spread quickly and progress.

Timely therapy is especially important during pregnancy. In this case, the disease may pose a threat to its progression. Careful selection of medications is also important: many of them are contraindicated, especially in the early stages. Their use can cause irreparable harm to the baby's health.

Groups of drugs for pyelonephritis and their characteristics

Therapy for the inflammatory process in the kidneys in women should be comprehensive. For this purpose, medications from several pharmacological groups are used for pyelonephritis. The most commonly used antibiotics are penicillin and cephalosporin drugs. They are prescribed in the form of tablets or intramuscular injections for a course of 1 to 2 weeks. The best way to select a medication from this group will be to analyze the sensitivity of the pathogen.

Antimicrobial synthetic agents that act bactericidal are included in the treatment. They can be divided into groups: fluoroquinolones, nitrofurans, hydroxyquinolines, sulfonamides. Herbal medicines are used for a long time to improve the condition of the kidneys. Be sure to use symptomatic remedies. These can be antispasmodics, antipyretics, non-steroidal anti-inflammatory, painkillers.

Review of the most used products

The most commonly prescribed tablets for pyelonephritis are penicillin in nature. The medicine called “Amoxiclav”, produced in 250, 500,
875 mg. The active substance is active against a large number of pathogenic pathogens and effectively destroys them. Take orally before meals three times a day, course from 5 to 14 days, the drug is contraindicated in case of individual intolerance to the components, liver diseases. The dosage is calculated by the attending physician specifically for each patient; it is not recommended to prescribe in the first trimester of pregnancy.

The amoxicillin series of antibiotics is represented by Flemoxin Solutab, which is resistant to the acidic environment of the stomach. This helps it maintain its unchanged appearance, provide a good therapeutic effect, the drug is effective against Proteus, streptococcus, take it two or three times a day in the amount prescribed by the doctor.

For the treatment of pyelonephritis, Nitroxoline is used, an antimicrobial, antiprotozoal drug, available in 50 mg tablets. The active substance suppresses pathogens such as tubercle bacilli and Trichomonas. Adults are usually prescribed 100 milligrams four times a day; in severe cases, the dose is doubled; it should be used with caution in patients with impaired renal function.

"Furadonin" is an inexpensive drug that is often the choice in the treatment of cystitis and pyelonephritis; it has an antimicrobial and antibacterial effect. The medication is taken after meals with plenty of water; it should be taken into account that the urine may turn yellow.

Furagin has a wide spectrum of action, successfully helping to fight kidney inflammation in most cases. Resistance to this drug develops very slowly, which is its positive quality. Your urine may turn orange when you use this medication.

A new third-generation antibiotic with a high rating, which has recently been included in the treatment of pyelonephritis, is Suprax. It is active against most pathogenic microorganisms in humans and has a small number of contraindications and side effects.

A plant-based drug called “Canephron” is used in the complex treatment of the urinary system. It helps with acute and chronic infections, prevents exacerbation, and is preventive in the formation of stones. The components contained in the drug have an antiseptic, antispasmodic effect, improve kidney function, and enhance the effect of antimicrobial medications.

The Heel company produces the homeopathic drug Solidago Compositum S for the treatment of inflammatory diseases in urology. It has a detoxifying, regenerating effect, and has a diuretic effect without side effects. Available in ampoules, quite expensive, the treatment regimen is prescribed by a doctor.

Traditionally, it is used in the form of injections, one ampoule 1 to 3 times a week for a month or a month and a half. A good therapeutic response of this drug is also observed in urolithiasis.

If pyelonephritis has become chronic, various complications have appeared, kidney function has been impaired, “Restrukta with injection C” is added to the treatment. It relieves inflammation, intoxication, and has an immunomodulatory effect. The medicine should not be prescribed during pregnancy. The course of treatment is the same as the previous medication. There is also a whole list of drugs produced by this company (Heel) that are auxiliary in the treatment of diseases of the urinary system.

Drug treatment of pregnant and lactating women

Pyelonephritis in women in an interesting position is very common. The danger of this condition is that, if left untreated, spontaneous abortion may occur in the second trimester. Intrauterine transmission of infection to a child is also possible.

Self-medication in this case is unacceptable; the expectant mother is prescribed antibiotics. Moreover, their use will cause much less harm than an untreated infection.

Attention! Prescriptions should be made exclusively by a doctor: there are many drugs that can only be used from the second or even third trimester. Their use in the early stages can cause serious pathologies in the fetus. Medicines for pyelonephritis in pregnant women can be based on ampicillin, methicillin, oxacillin.

Medicines for older women

When treating pyelonephritis in elderly women, it is important to prescribe medications after examining the condition of all organs and systems. All existing diseases must be taken into account. It is necessary to carry out bacteriological culture of urine to determine the sensitivity of the pathogen to antibiotics.

Most often, broad-spectrum agents are prescribed: cefuroxime, nolicin, amoxicillin. For elderly patients, aminoglycosides and lolimixins are not used. Doses should be 25-50% lower than generally accepted. After acute symptoms are relieved, doctors recommend maintenance therapy for geriatric patients for more than six months. Every month for at least ten days a course of some nitrofuran (for example, Furazolidone) is prescribed.

Next, herbal infusions that have diuretic and antiseptic properties are used at home. Using a decoction of Chinese rose helps to quickly cope with the disease and serves as a good folk prophylactic.

Prognosis of drug treatment of pyelonephritis

Prescribed drugs for pyelonephritis can quickly alleviate the patient’s condition and relieve acute symptoms. During the rapid course of the disease, the body temperature quickly decreases, the pain attack stops, and urine begins to pass more easily.

Chronic disease is more difficult to treat and recovery is slower. The disease cannot be completely cured; only a stage of remission occurs. If you follow all the rules of prevention and diet, this period can be long. But under adverse influences, the disease manifests itself again.

Preventive measures

By following a number of simple rules, you can prevent the development of pyelonephritis. If the disease is chronic, prevention will help avoid exacerbations and progression of the process. To do this, it is important to do the following:

Moderate physical activity, hardening, and sports will help normalize metabolic processes and promote better urine flow, which is an important aspect in the prevention of pyelonephritis and other inflammatory diseases of the genitourinary system.

Conclusion

Timely diagnosis, implementation of all medical recommendations, including drug treatment, lifestyle changes, giving up bad habits, and diet therapy help cope with pyelonephritis. It is important to try to prevent the acute process from becoming chronic.

If this happens, the patient should carefully monitor his health, undergo preventive examinations, and monitor the condition of the kidneys using tests and ultrasound. Such measures will help prevent serious complications and maintain the full functioning of paired organs.