XGP Which Antibiotics?

WHICH ANTIBIOTICS?

Intravenous
* piperacillin/tazobactam
* amikacin and metronidazole

pyrizinamide, ethambutol

The type of antibiotic depends on local practice, and may include
fluoroquinolones (e.g. ciprofloxacin), beta-lactam antibiotics (e.g.
amoxicillin or a cephalosporin), trimethoprim (alone or in combination
with sulfamethoxazole). Aminoglycosides are generally avoided due to
their toxicity, but may be added for a short duration
ACUTE ... ciprofloxacin IV 400 mg every 12 hours is the first line
treatment of choice. Alternatively, ampicillin IV 2g every 6 hours
plus gentamicin IV 1 mg/kg every 8 hours also provide excellent
coverage.

==================

Drug makers including [[Pfizer]] and [[Sanofi-Aventis]] are interested
in modern versions of Coley's
Toxins<ref>[http://www.nytimes.com/2005/10/05/business/05toll.html?_r=1&scp=2&sq=william%20B%20coley&st=cse
New York Times: article on Pfizer and Coley Pharmaceutical Group, 5
October 2005]</ref>; Pfizer has acquired the Coley Pharmaceutical
Group, set up in
1997<ref>[http://www.news-medical.net/news/2007/11/19/32636.aspx
news-medical.net: Pfizer to acquire Coley Pharmaceutical Group, 19
November 2007]</ref>

http://en.wikipedia.org/wiki/Pyelonephritis

Xanthogranulomatous pyelonephritis (XGP) is a rare form of chronic
pyelonephritis. With the review of the literature, we reported two
cases of XPN with psoas muscle abscesses caused by Staphylococci
aereus in one of the patient and Serratia mascerentes in the other.
Both of the patients had renal calculus. We performed nephrectomy with
psoas abscess drainage and started appropriate antibiotics, but one of
the patients died of septic shock. Other patient is free of symptoms
at the end of 5 years follow-up.

Keywords Psoas abscess - Xanthogranulomatous pyelonephritis

Case 1

The 17 year old male patient was presented with complain of left side
pain, difficulty in walking, high fever and general deterioration of
health.
The patient had been suffering from the left side pain for 1 month and
clinicians other than urology tried to treat the patient. He had
difficulty in walking for the last 1 week. He had severe left flank
tenderness and his left leg was in flexion, from the hip.
Pain became more severe when he extended his leg. Leukocyte count was
23,000. Urine sediment showed leukocyturia but urine culture was
sterile.
Computerrized tomography (CT) showed that the left renal parenchyma
thickness was severely reduced and no function was monitored on the
left kidney (Figure 1). There were many calculi in the kidneyl the
biggest at 1 cm diameter and thick walled collections at the dimension
of 12 x 8 x 6 cm3 existed, extending from the posterior pararenal area
along the psoas muscle (Figure 2). A culture was prepared from the
liquid extracted percutaneously and empiric triple antibiotic
treatment was commenced, using ceftriaxone, gentamisin and
metranidazol. Hte culture reproduced Staphylococci aereus. The patient
was explored and subjected to nephrectomy and the absess in the psaos
was drained. The histopathological evaluation of the kidney revealed
an appearance in compliance with XGP (Figure 3). Within the 48
postoperative months, the patient developed no problem.

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Xanthogranulomatous pyelonephritis mimicking malignant disease: is
preservation of the kidney possible?

A. Raziel, R. Steinberg, L. Kornreich, C. Mor and D. Golinsky, et al.

Xanthogranulomatous pyelonephritis (XGP) is an uncommon form of
pyelonephritis rarely seen in children. It is characterized by
destruction of the renal parenchyma and invasion of adjacent tissues,
mimicking renal tumors. Preoperative diagnosis is very difficult. Two
children with XGP are presented. One underwent nephrectomy and the
other drainage of a renal abscess with kidney preservation. Although
surgery is considered the only effective treatment, a high index of
suspicion and renal biopsy may prevent radical nephrectomy.

http://www.springerlink.com/content/t42p3820q14n0325/

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Medical treatment alone is inadequate to treat XGP; antibiotics are a
temporary measure for patients requiring medical investigation prior
to nephrectomy

BMJ Case Reports 2011; doi:10.1136/bcr.09.2010.3356

* Learning from errors

Xanthogranulomatous pyelonephritis in a young postpartal female

1. Vishal V Ramteke,
2. Makardhwaj S Shrivastava,
3. Brijesh A Agrawal,
4. Ankit D Raiyani,
5. Pramod A Darole,
6. Namita J Padwal,
7. Sandhya A Kamath

+ Author Affiliations

1.
Department of Medicine, Lokmanya Tilak Municipal Medical College
and General Hospital, Mumbai, India

1. Correspondence to Makardhwaj S Shrivastava, makar_in@rediffmail.com

Summary

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic
inflammatory disorder of the kidney characterised by an infectious
phlegmon arising in the renal parenchyma. It is seen in patients who
have urolithiasis, urinary tract infection and immunocompromised
status. The clinical presentation is variable and renal neoplasm is
considered as a differential due to its characteristic extrarenal
visceral invasion. The treatment is almost universally extirpative and
can pose a formidable challenge to the treating physician and surgeon.
The authors report a rare case of XGP in a postpartal woman who
presented with multiple visceral abscesses whose diagnosis was arrived
on histopathological examination.

http://casereports.bmj.com/content/2011/bcr.09.2010.3356.abstract