High-Dose, Short-Course Levofloxacin for Complicated Urinary Tract Infections and Acute Pyelonephritis

Introduction Acute pyelonephritis (AP) is a urinary tract infection (UTI) that passes from the lower urinary tract to the upper tract resulting in bacterial invasion of the renal parenchyma. Hematogenous spread to the kidney can occur in cases of endocarditis and IV drug abuse. There are an estimated 250,000 cases of AP per year in the United States. Most episodes are uncomplicated but hospitalization may be reAddress for correspondence Howard A. Klausner, MD Henry Ford Hospital, Department of Emergency Medicine, 2799 W. Grand Blvd., CFP 266 Detroit, Michigan 48202, USA Phone: 313-916-3428 Fax: 313-916-7437 E-mail: [email protected] quired for up to 10–30% cases (1). The development of secondary conditions, such as emphysematous pyelonephritis, perinephric abscess, or sepsis, can lead to significant mortality. Thus, early recognition and treatment is extremely important. Clinical features of uncomplicated AP include flank pain, abdominal pain, nausea, vomiting, fever and/or costovertebral tenderness. Symptoms of cystitis, dysuria or frequency, may or may From left to right Seth R. Strote, MD Howard A. Klausner, MD Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan, USA