Which medications in the drug class Antibiotics are used in the 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

Antibiotics

Infected hydronephrosis mandates IV antibiotic therapy in addition to urgent drainage via percutaneous nephrostomy or urethral stent placement. Aerobic gram-negative enteric organisms, including Escherichia coli and Klebsiella, Proteus, Enterobacter, and Citrobacter species, are typical pathogens. Enterococcal infection occasionally is seen in patients recently on antibiotics. Candida albicans sometimes is responsible in diabetic or immunosuppressed patients. Initial empiric antibiotic therapy should cover common bacterial pathogens.

Ampicillin

Ampicillin is a beta-lactam aminopenicillin antibiotic. Non–penicillinase-producing staphylococci and most streptococci are susceptible. Ampicillin is effective against E coli and Proteus and Enterococcus species, but most Klebsiella, Serratia, Acinetobacter, indole-positive Proteus, and Pseudomonas species and Bacteroides fragilis are resistant. Ampicillin is usually combined with gentamicin.

Gentamicin

Gentamicin is an aminoglycoside antibiotic, which is active against Staphylococcus aureus and Enterobacteriaceae organisms including E coli and Proteus, Klebsiella, Serratia, Enterobacter, and Citrobacter species. Pseudomonas aeruginosa is usually sensitive, although its sensitivity varies somewhat. When used in combination with ampicillin, gentamicin also effective against Enterococcus faecalis.

Ciprofloxacin (Cipro)

Ciprofloxacin is a reasonable alternative for treating infected hydronephrosis in penicillin-allergic patients. Fluoroquinolones are active against aerobic gram-negative organisms and generally effective against aerobic gram-positive organisms, though some resistance has been noted in S aureus and Streptococcus pneumoniae. Ciprofloxacin is not effective against anaerobes. It is variably effective against E faecalis, though ampicillin and gentamicin are likely to be more effective.

Levofloxacin (Levaquin)

Levofloxacin is a reasonable alternative for treating infected hydronephrosis in penicillin-allergic patients. Fluoroquinolones are active against aerobic gram-negative organisms and generally effective against aerobic gram-positive organisms, though some resistance has been noted in S aureus and S pneumoniae. Levofloxacin is not effective against anaerobes. It is variably effective against E faecalis, though ampicillin and gentamicin are likely to be more effective.

Ofloxacin

Ofloxacin is a reasonable alternative for treating infected hydronephrosis in penicillin-allergic patients. It is active against aerobic gram-negative organisms and generally effective against aerobic gram-positive organisms, though some resistance has been noted in S aureus and S pneumoniae. It is not effective against anaerobes. It is variably effective against E faecalis, though ampicillin and gentamicin are likely to be more effective.


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