Acute uncomplicated pyelonephritis

500 mg orally twice daily x 7 days; 14 days in male patients

Mild to moderate infections: Oral, immediate release: 10 mg/kg/dose twice daily; maximum dose: 500 mg/dose.

WATCH group - carries resistance cost. Egyptian EML 2025.

Egyptian National Drug Formulary - Antimicrobial 2023 (ciprofloxacin monograph, acute pyelonephritis), with the 14-day male course from Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt)

Ciprofloxacin is a fluoroquinolone that reaches high concentrations in the urinary tract and renal tissue, making it a first-line oral option for acute uncomplicated pyelonephritis outside of pregnancy. The disease article doubles the course in men - a fluoroquinolone for 7 days, and 14 days where the patient is male - where the Egyptian formulary gives 5 to 7 days for everyone; the international figure leads and the formulary's is on the row.

Acute Pyelonephritis - disease-level clinical article (pyelonephritis-clinical.txt)

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

1 to 2 double-strength tablets every 12 to 24 hours x 14 days

6-12 mg/kg/day [child max 320 mg]

(ENDF general dosing, susceptible infection, infants 2 months and over, children and adolescents: oral 6 to 12 mg TMP/kg/day in divided doses every 12 hours, maximum single dose 160 mg TMP. The mg/kg figures are the TRIMETHOPRIM component, not the combined tablet. Contraindicated in infants under 2 months.)

Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), sulfamethoxazole and trimethoprim monograph, Indications ("Treatment of urinary tract infections (UTIs)") and Dosage Regimen, Dosing: Adult, General dosing guidelines, with the 14-day course from Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt)

The card offered ciprofloxacin and nothing else, so a patient in whom a fluoroquinolone is unsuitable had no oral antibiotic at all. The disease article names the American College of Physicians recommendation of sulfamethoxazole-trimethoprim as the first-line alternative to a fluoroquinolone, and gives the course as 14 days. The ENDF indicates the combination for urinary tract infections caused by E. coli, Klebsiella, Enterobacter, Morganella and Proteus, and supplies the tablet figure, but states no duration at all and does not distinguish upper from lower urinary tract infection - it says 'urinary tract infections' and pyelonephritis is one. The 14 days on this row is therefore the article's figure, leading under the 2026-08-16 source ruling, and the citation names both documents. The ENDF lists tablets of 400/80 mg and 800/160 mg; 'double-strength' is the 800/160 mg tablet.

875/125 mg orally twice daily x 7 to 10 days

No paediatric dose is available from this source, which states the outpatient regimen for adults and gives no mg/kg figure.

Use this branch where community quinolone resistance runs above 10%. The source lists these three without ranking them, so the order here is practical, not a graded preference. Co-amoxiclav leads for treatment started before the culture result is back: it is the source's own first-listed option and the most widely stocked of the three in Egypt. Cefadroxil is the cephalosporin alternative. Co-trimoxazole comes last, for empiric use only - the article notes that growing resistance has made it a weaker blind choice, while also reporting that the American College of Physicians still lists it, at 14 days, as one option with a fluoroquinolone as the other. Both hold: weak as a first guess, strong once sensitivities confirm it. Send the culture, then let the result decide.

Acute Pyelonephritis - StatPearls - NCBI Bookshelf (NBK519537) - disease-level clinical article (pyelonephritis-full.txt) - verbatim: "If quinolone resistance in community-acquired infections is greater than 10%, choose one of the following (assuming bacterial sensitivity): Amoxicillin-clavulanate 875 mg orally twice daily for 7 to 10 days", under the heading "Appropriate empiric antibiotics for outpatients with acute pyelonephritis include".

The oral option to reach for when a fluoroquinolone is not appropriate - because local resistance is above 10%, or the patient cannot take one. Co-amoxiclav covers the Enterobacteriaceae that cause most pyelonephritis while sparing the quinolone class.

1 g orally twice daily x 7 to 10 days

No paediatric dose is available from this source, which states the outpatient regimen for adults and gives no mg/kg figure.

Acute Pyelonephritis - StatPearls - NCBI Bookshelf (NBK519537) - disease-level clinical article (pyelonephritis-full.txt) - verbatim: "If quinolone resistance in community-acquired infections is greater than 10%, choose one of the following (assuming bacterial sensitivity): ... Cefadroxil 1 g orally twice daily for 7 to 10 days", under the heading "Appropriate empiric antibiotics for outpatients with acute pyelonephritis include".

The cephalosporin option in the same list, for the patient who cannot take co-amoxiclav. The 1 g tablet is stocked widely and cheaply in Egypt.

1 to 2 g as a single intramuscular or intravenous dose - single dose

Adults only; a child with pyelonephritis needs referral rather than a clinic dose.

WATCH group - carries resistance cost. Egyptian EML 2025.

Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) - verbatim: "General Adult Dosage IV or IM 1-2 g once or devided twice daily."

One intramuscular dose in the clinic covers the patient while the culture is pending and the first oral doses take hold, which is what the guideline bodies advise wherever local resistance to the oral agents is common. It is given with the oral course, never instead of it.

5 mg/kg as a single dose - single dose

Adults only; a child with pyelonephritis needs referral rather than a clinic dose.

Egyptian National Drug Formulary - Antimicrobial 2023 (gentamicin monograph) - verbatim: "Outpatients: IV, IM: 5 mg/kg once, followed by 5 to 14 days of appropriate oral therapy"

A cheap, widely stocked alternative to a stat ceftriaxone dose where a gram-negative organism is likely, and the one aminoglycoside use that needs no serum level monitoring because it is a single dose. It is added to the oral course, not substituted for it.