Which empirical therapy is recommended for acute pyelonephritis following a urine culture?

In the context of treating acute pyelonephritis, empirical therapy is based on both local resistance patterns and the pharmacological properties of the antibiotics. The recommended empirical therapy for uncomplicated cases often includes trimethoprim-sulfamethoxazole, particularly in areas where the resistance rates are not excessively high, and for patients who do not have risk factors for extended-spectrum beta-lactamase (ESBL) producing organisms.

Trimethoprim-sulfamethoxazole acts by inhibiting bacterial folate synthesis, making it effective against many strains of Escherichia coli, which is the most common causative agent of uncomplicated pyelonephritis. This medication is usually well-tolerated, has good oral bioavailability, and achieves adequate renal concentrations.

In contrast, while ciprofloxacin is a fluoroquinolone that can also be effective, its use is typically reserved for cases where resistance is known to be lower, or when the individual has contraindications to other first-line agents. Nitrofurantoin is not recommended for pyelonephritis because it does not achieve adequate renal tissue concentrations to effectively treat the infection in the kidneys. Amoxicillin, on the other hand, may not cover many resistant strains of E