Patient-Directed Antimicrobial Duration in Acute Uncomplicated Pyelonephritis

Inclusion Criteria

• •Inclusion:
• •Females between 18 and 55 years of age
• •Diagnosis of acute uncomplicated pyelonephritis
• •Can be discharged home on oral antimicrobial treatment
• •Ability to provide written informed consent in English or Spanish
• •Exclusion:
• •Took antibiotics in the prior 48 hours
• •Insulin-dependent diabetes
• •End-stage liver disease
• •If the patient reports a penicillin allergy, and is deemed to be high-risk using the penicillin allergy clinical decision rule (PEN-FAST)
• •Serious allergy (e.g., angioedema, anaphylaxis) to the study medication or a similarly reported allergy to a cephalosporin
• •Known or identified hydronephrosis, obstruction, or abscess identified by emergency department ultrasound
• •Presence of a kidney stone
• •Pregnancy or lactation
• •Renal dysfunction (defined as creatinine clearance of less than 30 mL/min)
• •Renal transplantation
• •Complicated pyelonephritis (defined anatomical or functional abnormality of the urinary tract that predisposes to infection)
• •Need for additional antimicrobial therapy for a coexisting infection
• •Human immunodeficiency virus (HIV) infection, with either a recent (in the past 6 months) acquired immune deficiency syndrome-defining condition or a cluster of differentiation-4 (CD-4+) T lymphocyte count \<200/mm\^3