What is the role of antibiotic therapy in the emergency treatment of nephrolithiasis?

Updated: Jun 21, 2018
  • Author: Chirag N Dave, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Answer

Antibiotic use in patients with kidney stones remains controversial. Overuse of the more effective agents leaves only highly resistant bacteria, but failure to adequately treat a UTI complicated by an obstructing calculus can result in potentially life-threatening urosepsis and pyonephrosis.

Use antibiotics if a kidney stone or ureteral obstruction has been diagnosed and the patient has clinical evidence of a UTI. Evidence of a possible UTI includes an abnormal finding upon microscopic urinalysis, showing pyuria of 10 WBCs/hpf (or more WBCs than RBCs), bacteriuria, fever, or unexplained leukocytosis. Perform a urine culture in these cases because a culture cannot be performed reliably later should the infection prove resistant to the prescribed antibiotic.

Approximately 3% of patients being treated for renal colic are reported to develop a newly acquired UTI. While case numbers are not high, such an infection can dramatically complicate the clinical outcome for that patient. Base selection of the antibiotic on the patient’s presentation, reserving the most effective parenteral antibiotics for patients with frank sepsis or other high-risk characteristics.

The author’s preference for initial medical therapy for pain in patients with acute renal colic is to use IV or IM ketorolac for pain with metoclopramide for nausea. If this therapy is unsuccessful or if the case is deemed more severe, a narcotic such as morphine sulfate or meperidine is added as needed to control pain. An antibiotic is administered if any question of potential infection exists.


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