Acute Pyelonephritis

Management of acute pyelonephritis involves the following:

Acute uncomplicated pyelonephritis

Ciprofloxacin is the initial treatment of choice for uncomplicated pyelonephritis. Many UK hospitals advocate Trimethoprim as the first choice (taking into account the associated risk of Clostridium difficile from Ciprofloxacin).

If intravenous treatment is required, a single dose of gentamicin followed by Ciprofloxacin is a reasonable approach.  The intravenous dose can be given in the ED allowing the patient to be discharged on oral antibiotics.

Learning bite

Uncomplicated pyelonephritis in a well patient can usually be managed as an out-patient initially.

Acute complicated pyelonephritis

Patients with acute complicated pyelonephritis usually require admission and intravenous Ciprofloxacin, Piperacillin-tazobactam or Co-amoxiclav. Gentamycin may also be used. It is always worth checking with your local guidelines before prescribing. Intravenous therapy may be required initially if patients are vomiting or unable to take oral antibiotics. A 2 week course of antibiotics is usually advocated in cases of pyelonephritis.[13]