Empirical treatment in patients with acute obstructive pyelonephritis.

Acute obstructive pyelonephritis (AOP) is a urological life-threatening inflammatory condition that initially requires immediate urinary drainage and simultaneous prescribing of highly effective targeted antibacterial treatment. The empirical antibacterial therapy is always prescribed before urine culture and susceptibility testing are done. Percutaneous nephrostomy (PNS) and ureteral stenting (US) are the two options for urinary drainage in obstructed kidneys, while fluoroquinolones and 3(rd) generation cephalosporins are the main groups of antibacterial drugs that are recommended and are available for empirical AOP therapy. In our study we aimed to compare efficacy of fluoroquinolone ciprofloxacin vs 3(rd) generation cephalosporin ceftazidime in empirical antibacterial treatment of patients with acute obstructive pyelonephritis. We also tried to analyze the impact of urinary drainage option on cure rates. 241 AOP patients were randomized into two groups: Group 1, n=124 pts in whom percutaneous nephrostomy was performed urinary drainage and Group 2, n=117 pts, in whom ureteral stenting was made. Then each abovementioned group was also randomized into equal two subgroups (ciprofloxacin vs ceftazidime) depending on the empiric antibacterial treatment which was chosen. Our results revealed that cure rates in patients treated by ceftazidime were higher than those who were treated by ciprofloxacin. At late follow-up, the clinical cure rate in PNS group treated by ceftazidime was 95.2% vs 83.6% in ciprofloxacin arm, while the microbiological cure rates were 92.9% vs 80.0% correspondingly (p<0.05). At late follow-up, the clinical cure rate in US group treated by ceftazidime was 86.4% vs 74.1% in ciprofloxacin arm while the microbiological cure rates were 82.4% vs 69.4% correspondingly (p<0.05). We also concluded that percutaneous nephrostomy ensures a better clinical cure than ureteral stenting at early and late follow-ups regardless of the drug regimes which were chosen. Thus, in our opinion, percutaneous nephrostomy combined with ceftazidime treatment can be considered as the most effective option in patients with acute obstructive pyelonephritis.