Inpatient observation is often the safest disposition for patients with infected stones due to the risk of progressing to sepsis.  All antibiotics should take into account patient's previous sensitivities and local antibiograms
Treatment is targeted at E. coli, Enterococcus, Klebsiella, Proteus mirabilis, S. saprophyticus
Consider one dose of Ceftriaxone 1g IV or Gentamycin 7mg/kg IV if the regional susceptibility of TMP/SMX or Fluoroquinolones is <80%
Ciprofloxacin 500mg PO BID x7 days OR
Trimethoprim-Sulfamethoxazole DS 160/800mg PO BID x14 days OR
Cephalexin 500mg QID PO x 10-14 days (OR consider 1000mg BID if difficulty with QID regimen) OR
Cefdinir 300mg BID PO x 10-14 days OR
Cefpodoxime 200mg PO BID x 10 days OR
Cefixime 400mg PO daily x 10 days OR
Levofloxacin 750mg PO QD x7 days
Ciprofloxacin 400mg IV q12hr OR
Ceftriaxone 1gm IV QD (Preferred in pregnancy) OR
Cefotaxime 1-2gm IV q8hr OR
Gentamicin 3mg/kg/day divided q8hr +/- ampicillin 1–2 gm q4hr OR
Piperacillin/Tazobactam 3.375 gm IV q6hr OR
Cefepime 2gm IV q8hr OR
Imipenem 500mg IV q8hr
Ceftriaxone 75mg/kg IV QD OR
Cefotaxime 50mg/kg IV q8hrs OR
Ampicillin 25mg/kg IV q6hrs + Gentamicin 2.5mg/kg IV q8hrs
Considered for ureterolithiasis with:
Persistent obstruction
Failure of stone progression
Increasing or unremitting colic
Staghorn calculi
Urolithiasis
Nephrolithiasis is most common misdiagnosis given to patients with rupturing AAA
Pyelonephritis
Vascular
Acute cystitis
Abdominal aortic aneurysm
Interstitial cystitis
Renal artery embolism