**Upper Urinary Tract Infections** **Predisposing Factors:** * Female gender * Pregnancy * Sexual activity * Urinary tract obstruction * Diabetes mellitus * Immunosuppression * Indwelling urinary catheters * Recent urinary tract instrumentation **Ascending Infection:** * E. coli (most common) * Klebsiella * Proteus * Enterococcus * Pseudomonas **Hematogenous Spread:** * S. aureus * Candida * Mycobacterium tuberculosis **Clinical Manifestations:** * Fever * Chills * Flank pain * Costovertebral angle tenderness * Nausea and vomiting * Dysuria * Frequency * Urgency * Hematuria * Suprapubic pain **Diagnosis:** * Urinalysis: * Leukocyte esterase positive * Nitrite positive * Pyuria * Bacteriuria * Urine culture and sensitivity * Blood tests: * Complete blood count (CBC) * Blood urea nitrogen (BUN) * Creatinine * Imaging studies: * Ultrasound * CT scan * Intravenous pyelogram (IVP) **Treatment:** * **Antibiotics:** * Ciprofloxacin 500 mg PO BID x 7 days * Levofloxacin 750 mg PO daily x 7 days * Trimethoprim-sulfamethoxazole DS 1 tab BID x 7 days * Nitrofurantoin 100 mg BID x 7 days * Amoxicillin-clavulanate 875 mg BID x 7 days * **For severe infections:** * Ceftriaxone 1 g IV daily * Gentamicin 5 mg/kg IV daily * **Other:** * Adequate hydration * Pain relief * Hospitalization for severe cases