Relevancy. The Russian society of urologists recommends the use of fluoroquinolones as a starting mode of therapy for acute pyelonephritis in regions with the level of resistance of extrahospital uropathogens to fluoroquinolones less than 10%. Despite the resistance level in St. Petersburg in 2004 of 13%, fluoroquinolones remain first-line drugs in the treatment of patients with acute pyelonephritis at the hospitals. Purpose. Cost-benefit analysis of different variants of empirical antibacterial therapy for uncomplicated pyelonephritis in hospital care. Materials and methods. The calculations take into account the literature data on the effectiveness, safety, utility (Quality-Adjusted Life Days - QALDs) of the starting regime of antibacterial therapy of uncomplicated pyelonephritis with cephalosporins of the 3rd generation, fluoroquinolones, aminoglycosides and carbapenems in terms of hospital specialized medical care. The model of‘decision tree’ is constructed. A list of direct and non-direct costs was compiled, on the basis of which the cost of 1 case of acute uncomplicated pyelonephritis therapy for each strategy of antibacterial therapy was calculated. The cost-utility analysis was performed. Results and discussion. Cost-utility analysis demonstrated that the strategy of therapy of acute uncomplicated pyelonephritis gentamicin was dominated by the strategy of therapy with ciprofloxacin, as with less had a greater usefulness; dominated strategy ceftriaxone, as equal usefulness was less expensive. As for the comparison of the strategy of therapy with acute pyelonephritis gentamicin therapy ertapenem, the cost analysis showed that the additional utility of 0.001 QALDs will require an additional 16 894 680 rubles, which is higher than the threshold of willingness to pay in Russia. Conclusions. The strategy of therapy of acute pyelonephritis with aminoglycosides including in regions with the level of resistance of the main pathogens more than 10% is not only effective and safe, but also economically feasible.