# Acute uncomplicated pyelonephritis - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: IDSA Guidelines for Uncomplicated UTI and Pyelonephritis 2011 · Egyptian National Drug Formulary - Antimicrobial 2023 (cefixime monograph) · Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (ciprofloxacin monograph, acute pyelonephritis), with the 14-day male course from Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), sulfamethoxazole and trimethoprim monograph, Indications ("Treatment of urinary tract infections (UTIs)") and Dosage Regimen, Dosing: Adult, General dosing guidelines, with the 14-day course from Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (gentamicin monograph) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Antimicrobial 2023 (cefixime monograph) - Acute Pyelonephritis - disease-level clinical article (pyelonephritis-clinical.txt) - Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 (ciprofloxacin monograph, acute pyelonephritis), with the 14-day male course from Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), sulfamethoxazole and trimethoprim monograph, Indications ("Treatment of urinary tract infections (UTIs)") and Dosage Regimen, Dosing: Adult, General dosing guidelines, with the 14-day course from Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt) ## Treatment metadata - Ciprofloxacin — 500 mg — oral.solid - Referral & safety-netting (no drug therapy) - Sulphamethoxazole + Trimethoprim — 800 mg — oral.solid - Amoxicillin + Clavulanic acid — 1000 mg — oral.solid - Cefadroxil — 1000 mg — oral.solid - Ceftriaxone — injection - Gentamicin — injection ## Complete treatment card ```text ACUTE UNCOMPLICATED PYELONEPHRITIS Sources: IDSA Guidelines for Uncomplicated UTI and Pyelonephritis 2011 · Egyptian National Drug Formulary - Antimicrobial 2023 (cefixime monograph) · Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (ciprofloxacin monograph, acute pyelonephritis), with the 14-day male course from Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), sulfamethoxazole and trimethoprim monograph, Indications ("Treatment of urinary tract infections (UTIs)") and Dosage Regimen, Dosing: Adult, General dosing guidelines, with the 14-day course from Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt) · Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (gentamicin monograph) Review status: REVIEWED against Egyptian National Drug Formulary - Antimicrobial 2023 (cefixime monograph), Acute Pyelonephritis - disease-level clinical article (pyelonephritis-clinical.txt), Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt), Egyptian National Drug Formulary - Antimicrobial 2023 (ciprofloxacin monograph, acute pyelonephritis), with the 14-day male course from Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt), Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), sulfamethoxazole and trimethoprim monograph, Indications ("Treatment of urinary tract infections (UTIs)") and Dosage Regimen, Dosing: Adult, General dosing guidelines, with the 14-day course from Pyelonephritis - disease-level clinical article (pyelonephritis- full.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - The classic triad is flank pain with fever and nausea or vomiting, but any one of the three may be missing. [abdominal pain · fever · loin pain · nausea · vomiting] - When nausea and vomiting are absent, poor appetite is a common presenting complaint instead. [poor appetite] - Onset is fairly rapid, with symptoms building over a matter of hours to about a day. - Painful urination and blood in the urine, the cystitis-type complaints, occur more often in women. [blood in the urine · burning on passing urine] - Neonates and infants under two may show poor feeding and failure to thrive rather than the classic picture. [failure to thrive · poor feeding] - Older adults can present atypically, with new confusion or altered mental status rather than typical urinary complaints. [confusion] - Alongside fever and flank pain the complaints include chills, nausea and vomiting, poor appetite, burning on urination, frequency and urgency [abdominal pain · chills · fever · loin pain · nausea · poor appetite · vomiting] - It usually climbs from the bladder up to the kidney, though it can also arrive through the bloodstream - Chronic pyelonephritis is the scarring and long-term inflammation left behind by repeated or persistent infection, usually with vesicoureteral reflux or another urological abnormality in a child [scarring] SIGNS - what you find (8) - Fever can run quite high, sometimes above 103°F (39.4°C). [fever] - Despite a high fever, most patients do not look toxic or critically unwell on exam. [fever] - A systolic pressure under 90 mm Hg is a warning sign for evolving sepsis. [sepsis] - Tenderness on percussion over the affected kidney is usually one-sided but can occasionally be bilateral. - Tenderness just above the pubic bone ranges from mild to moderate on exam. - Peritoneal findings such as rebound, guarding, or rigidity are typically not present. - Bowel sounds remain normal and active on abdominal exam. - The skin should look unremarkable, so a visible rash points instead toward shingles. [rash] TESTS (12) - Urine should be sent for urinalysis and culture in every patient where the diagnosis is suspected. - Up to 30 percent of cultures come back negative despite true infection, often when outpatient antibiotics were already started. - Pus cells in the urine (pyuria) are the most frequent urinalysis abnormality seen. - Only about a quarter of infected patients test positive for nitrites, so a negative dipstick does not clear the diagnosis. - Visible blood in the urine is far more common in young women with the infection than in affected men. - Routine imaging is not needed for a straightforward case but should be considered when risk factors are present. - CT of the abdomen and pelvis, done with and without contrast, is the preferred imaging test when imaging is warranted. - A normal ultrasound result does not rule the diagnosis out. - Focal, wedge-shaped areas of reduced enhancement on contrast CT are the characteristic finding. - A stone cannot be excluded by exam alone, so a non-contrast phase is included to look for one. - It counts as complicated in pregnancy, in uncontrolled diabetes, after a kidney transplant, with an anatomical abnormality of the urinary tract, in kidney failure, in the immunocompromised, and when the infection was caught in hospital - Separating complicated from uncomplicated is what decides the treatment and whether the patient can be sent home IF NOT THIS - what else fits (5) - Failure to improve after a course of IV antibiotics should raise concern for obstructive pyonephrosis, and a CT urogram can help confirm it. - A visible rash points toward shingles rather than pyelonephritis, since the skin exam should otherwise be normal. - Appendicitis, cholecystitis, and costochondritis are also named as conditions that can mimic pyelonephritis. - Ovarian cyst pathology and pancreatitis are further listed among the pyelonephritis mimics. - A renal abscess or a rib fracture likewise appear on the pyelonephritis differential list. Source StatPearls "Acute Pyelonephritis" - disease-level clinical article Status traced to the source above Rx: Main treatment | Oral antibiotic - fluoroquinolone-sparing alternative | Single parenteral dose before the oral course | Single IM dose given with the oral course MAIN TREATMENT - choose one 1. CIPROFLOXACIN [1st line] Adult 500 mg orally twice daily x 7 days; 14 days in male patients Peds Mild to moderate infections: Oral, immediate release: 10 mg/kg/dose twice daily; maximum dose: 500 mg/dose. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 (ciprofloxacin monograph, acute pyelonephritis), with the 14-day male course from Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt) Why Ciprofloxacin is a fluoroquinolone that reaches high concentrations in the urinary tract and renal tissue, making it a first-line oral option for acute uncomplicated pyelonephritis outside of pregnancy. The disease article doubles the course in men - a fluoroquinolone for 7 days, and 14 days where the patient is male - where the Egyptian formulary gives 5 to 7 days for everyone; the international figure leads and the formulary's is on the row. Caution Avoid in pregnancy (use ceftriaxone or cefixime instead). Admit to hospital if vomiting, septic, pregnant, or failing oral therapy after 48h. Men need the longer course. The disease article's outpatient regimen applies where quinolone resistance in community-acquired infection runs at 10% or under: a fluoroquinolone for 7 days, extended to 14 days in a man. The Egyptian formulary gives no separate male course - for acute pyelonephritis or another complicated UTI it lists the immediate-release oral form at 500 mg, one dose every 12 hours, and 5 to 7 days in all, with no distinction by sex. The article adds that where community fluoroquinolone resistance exceeds 10%, an initial parenteral dose (for example ceftriaxone) should precede the oral course. There is a risk of tendonitis, tendon rupture, and QT prolongation. Egypt QUINOLOROX 500MG 10 F.C. TAB. EPCI > ROXXEN 10.00 EGP (1.00/unit) ECACIPROFLOX 500 MG 20 F.C. TABS. FUTURE PHARMACEUTICAL INDU... 27.00 EGP (1.35/unit) ELMODOXACIN 500MG 10 F.C.TAB. EGPI > SEA PHARM 20.00 EGP (2.00/unit) CIPROQUIN 500MG 10 F.C. TAB. UNIPHARMA 50.00 EGP (5.00/unit) CIPROFLOXACIN-ORGANO 500 MG 10 F.C.TABS. ORGANOPHARMA > ORGANO 63.00 EGP (6.30/unit) CIPROFAR 500MG 10 F.C.TAB. PHARCO 69.00 EGP (6.90/unit) CIPROMEGA XL 500MG 10 EXT. REL. F.C.TABS. MASH PREMIERE 48.00 EGP HEROXACIN 500MG 10 SCORED F.C. TAB. EGPI > HERO PHARM 69.00 EGP 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Acute Pyelonephritis - disease-level clinical article (pyelonephritis-clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - The indications for hospital admission rather than outpatient oral antibiotics are sepsis, high fever, uncontrolled pain, persistent vomiting, immunocompromise, pregnancy, poorly controlled diabetes, transplant recipients, or suspected obstruction. RED FLAG - Obstructive pyelonephritis (pyonephrosis) is a surgical emergency needing urgent drainage, not antibiotics alone. ORAL ANTIBIOTIC - FLUOROQUINOLONE-SPARING ALTERNATIVE - choose one 3. SULPHAMETHOXAZOLE + TRIMETHOPRIM [2nd line] Adult 1 to 2 double-strength tablets every 12 to 24 hours x 14 days Peds 6-12 mg/kg/day [child max 320 mg] (ENDF general dosing, susceptible infection, infants 2 months and over, children and adolescents: oral 6 to 12 mg TMP/kg/day in divided doses every 12 hours, maximum single dose 160 mg TMP. The mg/kg figures are the TRIMETHOPRIM component, not the combined tablet. Contraindicated in infants under 2 months.) 2 months and over: 6 to 12 mg trimethoprim/kg/day in divided doses every 12 hours, maximum single dose 160 mg trimethoprim. Contraindicated under 2 months. 3kg -> 18-36 mg/day 4kg -> 24-48 mg/day 5kg -> 30-60 mg/day 6kg -> 36-72 mg/day 7kg -> 42-84 mg/day 8kg -> 48-96 mg/day 9kg -> 54-108 mg/day 10kg -> 60-120 mg/day 11kg -> 66-132 mg/day 12kg -> 72-144 mg/day 13kg -> 78-156 mg/day 14kg -> 84-168 mg/day 15kg -> 90-180 mg/day 16kg -> 96-192 mg/day 17kg -> 102-204 mg/day 18kg -> 108-216 mg/day 19kg -> 114-228 mg/day 20kg -> 120-240 mg/day 21kg -> 126-252 mg/day 22kg -> 132-264 mg/day 23kg -> 138-276 mg/day 24kg -> 144-288 mg/day 25kg -> 150-300 mg/day 26kg -> 156-312 mg/day 27kg -> 162-320 mg/day (upper capped) 28kg -> 168-320 mg/day (upper capped) 29kg -> 174-320 mg/day (upper capped) 30kg -> 180-320 mg/day (upper capped) 31kg -> 186-320 mg/day (upper capped) 32kg -> 192-320 mg/day (upper capped) 33kg -> 198-320 mg/day (upper capped) 34kg -> 204-320 mg/day (upper capped) 35kg -> 210-320 mg/day (upper capped) 36kg -> 216-320 mg/day (upper capped) 37kg -> 222-320 mg/day (upper capped) 38kg -> 228-320 mg/day (upper capped) 39kg -> 234-320 mg/day (upper capped) 40kg -> 240-320 mg/day (upper capped) 41kg -> 246-320 mg/day (upper capped) 42kg -> 252-320 mg/day (upper capped) 43kg -> 258-320 mg/day (upper capped) 44kg -> 264-320 mg/day (upper capped) 45kg -> 270-320 mg/day (upper capped) 46kg -> 276-320 mg/day (upper capped) 47kg -> 282-320 mg/day (upper capped) 48kg -> 288-320 mg/day (upper capped) 49kg -> 294-320 mg/day (upper capped) 50kg -> 300-320 mg/day (upper capped) Source Egyptian National Drug Formulary - Antimicrobial 2023 (Version 1.0), sulfamethoxazole and trimethoprim monograph, Indications ("Treatment of urinary tract infections (UTIs)") and Dosage Regimen, Dosing: Adult, General dosing guidelines, with the 14-day course from Pyelonephritis - disease-level clinical article (pyelonephritis-full.txt) Why The card offered ciprofloxacin and nothing else, so a patient in whom a fluoroquinolone is unsuitable had no oral antibiotic at all. The disease article names the American College of Physicians recommendation of sulfamethoxazole-trimethoprim as the first-line alternative to a fluoroquinolone, and gives the course as 14 days. The ENDF indicates the combination for urinary tract infections caused by E. coli, Klebsiella, Enterobacter, Morganella and Proteus, and supplies the tablet figure, but states no duration at all and does not distinguish upper from lower urinary tract infection - it says 'urinary tract infections' and pyelonephritis is one. The 14 days on this row is therefore the article's figure, leading under the 2026-08-16 source ruling, and the citation names both documents. The ENDF lists tablets of 400/80 mg and 800/160 mg; 'double-strength' is the 800/160 mg tablet. Caution Hypersensitivity to any sulfa drug, trimethoprim, or any component of the formulation; history of drug induced-immune thrombocytopenia with use of sulfonamides or trimethoprim; megaloblastic anemia due to folate deficiency; infants <2 months Additional contraindications: Blood dyscrasias; pregnancy; breastfeeding; premature infants; acute porphyria. Serum creatinine and potassium concentrations should be monitored in outpatients receiving high-dose therapy. Adults with Clcr 15-30 mL/minute: Reduce dose to ~50% of usual dose. The formulary states no duration for this indication; the 14-day course named in the disease article is the American College of Physicians' recommendation, not the formulary's. The 14 days is the disease article's figure: in uncomplicated pyelonephritis the American College of Physicians puts sulfamethoxazole-trimethoprim at 14 days, or a fluoroquinolone at 5 to 7 days, the choice resting on local resistance patterns and on the sensitivities the urine culture returns. Egypt CO-TRIMOXAZOLE 20 TABS. MUP 5.00 EGP (0.25/unit) -> ? strength differs COTRIL 400/80MG 20 TAB. EL NASR 38.00 EGP (1.90/unit) -> ? strength differs SEPTAZOLE FORTE 800/160MG 20 TABS. ALEXANDRIA 56.00 EGP (2.80/unit) -> ? strength differs SEPTRIN D.S 10 TABS. GLAXO SMITHKL... 28.00 EGP (2.80/unit) -> ? strength differs SEPTAZOLE 400/80MG 20*10 TABS. ALEXANDRIA 340.00 EGP (34.00/unit) -> ? strength differs SUTRIM 400/80MG 20*10 TAB. MEMPHIS 340.00 EGP (34.00/unit) -> ? strength differs CO-TRIMOXAZOLE 200/40MG SUSP. 120ML MUP 6.00 EGP -> ? strength differs, ? different route - not oral solid SUTRIM 200/40MG SUSP. 100ML MEMPHIS 18.50 EGP -> ? strength differs, ? different route - not oral solid 4. AMOXICILLIN + CLAVULANIC ACID [2nd line] Adult 875/125 mg orally twice daily x 7 to 10 days Peds No paediatric dose is available from this source, which states the outpatient regimen for adults and gives no mg/kg figure. Choice Use this branch where community quinolone resistance runs above 10%. The source lists these three without ranking them, so the order here is practical, not a graded preference. Co-amoxiclav leads for treatment started before the culture result is back: it is the source's own first-listed option and the most widely stocked of the three in Egypt. Cefadroxil is the cephalosporin alternative. Co-trimoxazole comes last, for empiric use only - the article notes that growing resistance has made it a weaker blind choice, while also reporting that the American College of Physicians still lists it, at 14 days, as one option with a fluoroquinolone as the other. Both hold: weak as a first guess, strong once sensitivities confirm it. Send the culture, then let the result decide. Source Acute Pyelonephritis - StatPearls - NCBI Bookshelf (NBK519537) - disease-level clinical article (pyelonephritis-full.txt) - verbatim: "If quinolone resistance in community- acquired infections is greater than 10%, choose one of the following (assuming bacterial sensitivity): Amoxicillin-clavulanate 875 mg orally twice daily for 7 to 10 days", under the heading "Appropriate empiric antibiotics for outpatients with acute pyelonephritis include". Why The oral option to reach for when a fluoroquinolone is not appropriate - because local resistance is above 10%, or the patient cannot take one. Co-amoxiclav covers the Enterobacteriaceae that cause most pyelonephritis while sparing the quinolone class. Caution This is the branch for community quinolone resistance above 10%. Where it is 10% or under, the fluoroquinolone above is the first-line choice. Send a urine culture before the first dose and change to a narrower agent once sensitivities are back - the source is explicit that therapy should be narrowed whenever it safely can be. Oral therapy is for the outpatient who is not septic. Admit for sepsis, high fever, uncontrolled pain, persistent vomiting, immunocompromise, pregnancy, poorly controlled diabetes, transplant, or suspected obstruction. Review at 24 to 48 hours. Failure to improve on oral therapy is itself an indication for admission. Egypt E-MOXCLAV 1G 10 F.C. TAB. EIPICO 14.00 EGP (1.40/unit) JULMENTIN 2X 1GM 15 TAB. JULPHAR 57.50 EGP (3.83/unit) DEXICLAVE 1 GM 10 F.C. TABS. RAMEDA > NOVE... 38.50 EGP (3.85/unit) MACLAVEX 1 GM 14 F.C.TABS. MASH PREMIERE 105.00 EGP (7.50/unit) CLAVIMOX 1 GM 12 F.C.TABS. PHARCO 130.00 EGP (10.83/unit) MEGAMOX 1 GM 14 F.C. TABS. AL JAZEERA PH... 178.00 EGP (12.71/unit) CLAVOCILLIN 1 GM 10 DISPERSIBLE TABS. RAMEDA > ORGANOPHARMA 106.00 EGP AUGMENTIN ADULTS 1GM/125MG 12 PWD. ORAL SUSP. SACHETS GLAXO SMITHKLINE 169.00 EGP LARYNCLAVE 125/31 PD. FOR ORAL SUSP. 70ML MISR > AL ROWAD PHARMACEUTICAL... 8.00 EGP -> ? strength differs, ? different route - not oral solid MEGACLAVOX 156MG/5ML PD. FOR SUSP. 60 ML CID 8.00 EGP -> ? strength differs, ? different route - not oral solid 5. CEFADROXIL [2nd line] Adult 1 g orally twice daily x 7 to 10 days Peds No paediatric dose is available from this source, which states the outpatient regimen for adults and gives no mg/kg figure. Source Acute Pyelonephritis - StatPearls - NCBI Bookshelf (NBK519537) - disease-level clinical article (pyelonephritis-full.txt) - verbatim: "If quinolone resistance in community- acquired infections is greater than 10%, choose one of the following (assuming bacterial sensitivity): ... Cefadroxil 1 g orally twice daily for 7 to 10 days", under the heading "Appropriate empiric antibiotics for outpatients with acute pyelonephritis include". Why The cephalosporin option in the same list, for the patient who cannot take co-amoxiclav. The 1 g tablet is stocked widely and cheaply in Egypt. Caution This is the branch for community quinolone resistance above 10%. Where it is 10% or under, the fluoroquinolone above is the first-line choice. 1 g twice a day, not the 500 mg twice a day used for skin and throat infections. The kidney dose is the higher one. Send a urine culture before the first dose and narrow the agent once sensitivities are back. Avoid after a severe or immediate reaction to a penicillin. Cephalosporins carry a cross-reactivity risk, and this source does not quantify it, so no figure is given here. Egypt CEFIX 1000MG 8 F.C.TAB. SIGMA TEC > F... 10.00 EGP (1.25/unit) BIODROXIL 1 GM 8 F.C.TAB. KAHIRA > NOVA... 15.00 EGP (1.88/unit) CEFEX 1 GM 8 F.C.TABS. SIGMA TEC > F... 22.50 EGP (2.81/unit) CURISAFE 1 GM 8 F.C. TABS. PHARCO B 76.00 EGP (9.50/unit) DURICEF 1 GM 8 F.C. TABS. SMITHKLINE BE... 78.00 EGP (9.75/unit) CEFADROXIL 1 GM 6 DISPERSIBLE TAB. SIGMA 12.00 EGP DURICEF 1 GM 6 DISPERSABLE TAB. SMITHKLINE BE... 58.00 EGP LONGICEF 125MG/5ML SUSP. 60 ML KAHIRA 4.25 EGP -> ? strength differs, ? different route - not oral solid CEFADROXIL 250MG/5ML PD. FOR ORAL SUSP. 60ML SIGMA 7.50 EGP -> ? strength differs, ? different route - not oral solid SINGLE PARENTERAL DOSE BEFORE THE ORAL COURSE - give alongside 6. CEFTRIAXONE [add-on - not a substitute] Adult 1 to 2 g as a single intramuscular or intravenous dose - single dose Peds Adults only; a child with pyelonephritis needs referral rather than a clinic dose. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph) - verbatim: "General Adult Dosage IV or IM 1-2 g once or devided twice daily." Why One intramuscular dose in the clinic covers the patient while the culture is pending and the first oral doses take hold, which is what the guideline bodies advise wherever local resistance to the oral agents is common. It is given with the oral course, never instead of it. Caution Do not give it to anyone who has had anaphylaxis to ceftriaxone, another cephalosporin, a penicillin or any other beta-lactam. It is an add-on: start the oral course as well, and review the patient against the urine culture. Egypt CEFAXONE 250MG I.V. VIAL. PHARCO B 15.00 EGP CEFOTRIX 250MG I.V.VIAL (U.S.P.23) UP PHARMA 15.00 EGP TRIXOMASH 500MG VIAL FOR I.V. INJ. RAMEDA > MASH PREMIERE 16.50 EGP TRIAXONE 500MG VIAL FOR I.M. INJ. TABUK PHARMACEUTICAL MANUFACTURING COM... 36.00 EGP WINTRIAXONE 1 GM PD. FOR I.M INJ. SANOFI 48.00 EGP CEFTRIAXONE-SANDOZ 500 MG I.M. VIAL PHARCO B > SANDOZ 62.00 EGP TRIAXONE 1 GM I.M. VIAL TABUK PHARMAC... 106.00 EGP TRIAXONE 1 GM I.V VIAL TABUK PHARMAC... 106.00 EGP SINGLE IM DOSE GIVEN WITH THE ORAL COURSE - give alongside 7. GENTAMICIN [add-on - not a substitute] Adult 5 mg/kg as a single dose - single dose Peds Adults only; a child with pyelonephritis needs referral rather than a clinic dose. Source Egyptian National Drug Formulary - Antimicrobial 2023 (gentamicin monograph) - verbatim: "Outpatients: IV, IM: 5 mg/kg once, followed by 5 to 14 days of appropriate oral therapy" Why A cheap, widely stocked alternative to a stat ceftriaxone dose where a gram-negative organism is likely, and the one aminoglycoside use that needs no serum level monitoring because it is a single dose. It is added to the oral course, not substituted for it. Caution Weigh the patient - the dose is per kilogram, and a guessed weight is the usual cause of an aminoglycoside overdose. Aminoglycosides can damage hearing and cause tinnitus; that risk goes with sustained high levels, which is why it is given as one dose and not a course. Use caution when the creatinine clearance is under 40 mL/min, and avoid it in pregnancy. Egypt REFOBACIN 40MG 3 AMP. GLAXO SMITHKL... 6.00 EGP REFOBACIN 80MG 3 AMP. GLAXO SMITHKL... 9.00 EGP GENTAMICIN-ALEX 20MG/2ML 6 AMP. ALEXANDRIA 12.00 EGP EPIGENT 20MG/2ML I.V./I.M. 3 AMPS. EIPICO 24.00 EGP GENTAMICIN-ALEX 80MG/2ML 3 AMP. I.M/I.V INJ. ALEXANDRIA 52.50 EGP EPIGENT 80MG/2ML I.M./I.V. 3 AMPS. EIPICO 54.00 EGP GARAMYCIN 20MG/2ML 6 AMPS. MEMPHIS 66.00 EGP GARAMYCIN 40MG/ML 6 AMPS. MEMPHIS 72.00 EGP Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)