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Pyelonephritis - acute - Management
How do I manage a person with suspected acute pyelonephritis in primary care?

  • Arrange admission, if this is indicated. See Admission or treatment for further information.
  • Obtain a midstream (or catheter specimen) of urine for culture and sensitivity testing before starting empirical antibiotics.
  • Prescribe an antibiotic.
    • For women who are not pregnant, men, and people with indwelling catheters:
      • Treat with ciprofloxacin 500 mg twice daily for 7 days.
      • Co-amoxiclav 500/125 mg three times a day for 14 days is an alternative.
    • For pregnant women who do not require admission:
      • Treat with cefalexin 500 mg twice daily for 10 to 14 days.
  • Treat pain and fever with paracetamol.
  • Maintain full hydration — advise sufficient fluid intake to ensure frequent passage of pale-coloured urine.
  • Review 24 hours after starting treatment and arrange admission if there is any clinical deterioration or the person does not respond to treatment.
  • Review culture and sensitivity results when they become available, and change the antibiotic if indicated.
  • Consider referral for investigation of an underlying abnormality of the renal tract, for:
    • Men, following their first episode of acute pyelonephritis.
    • Women, following two or more episodes of acute pyelonephritis.
    • All people with a urinary tract infection caused by Proteus species.

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