Editing Pyelonephritis (section)

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A 2018 systematic review recommended the use of norfloxacin as it has the lowest rate of side effects with a comparable efficacy to commonly used antibiotics.<ref name="Cattrall Robinson Kirby 2018 pp. 2285–2291">{{cite journal | vauthors = Cattrall JW, Robinson AV, Kirby A | title = A systematic review of randomised clinical trials for oral antibiotic treatment of acute pyelonephritis | journal = European Journal of Clinical Microbiology & Infectious Diseases | volume = 37 | issue = 12 | pages = 2285–2291 | date = December 2018 | pmid = 30191339 | doi = 10.1007/s10096-018-3371-y | doi-access = free | title-link = doi }}</ref>

In people who do not require hospitalization and live in an area where there is a low prevalence of [[Antibiotic resistance|antibiotic-resistant]] bacteria, a fluoroquinolone by mouth such as [[ciprofloxacin]] or [[levofloxacin]] is an appropriate initial choice for therapy.<ref name=Fer2018/> In areas where there is a higher prevalence of fluoroquinolone resistance, it is useful to initiate treatment with a single intravenous dose of a long-acting antibiotic such as [[ceftriaxone]] or an aminoglycoside, and then continuing treatment with a fluoroquinolone. Oral trimethoprim/sulfamethoxazole is an appropriate choice for therapy if the bacteria is known to be susceptible.<ref name=Fer2018/> If trimethoprim/sulfamethoxazole is used when the susceptibility is not known, it is useful to initiate treatment with a single intravenous dose of a long-acting antibiotic such as ceftriaxone or an aminoglycoside. Oral [[beta-lactam antibiotic]]s are less effective than other available agents for treatment of pyelonephritis.<ref name=Gupta2011/> Improvement is expected in 48 to 72 hours.<ref name=Fer2018/>