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Pyelonephritis - acute - Management
Basis for recommendation
Antibiotics
- These recommendations conform with Health Protection Agency (HPA) advice [HPA and Association of Medical Microbiologists, 2008].
- The HPA recommend ciprofloxacin and co-amoxiclav for the empirical treatment of acute pyelonephritis. This is based on the need to cover the broad spectrum of pathogens that cause acute pyelonephritis, and their excellent kidney penetration. Cefalexin has a reduced spectrum of activity, but is considered to have a better safety profile in pregnant women.
- Although ciprofloxacin, cefalexin, and co-amoxiclav are associated with an increased risk of Clostridium difficile, meticillin-resistant Staphylococcus aureus (MRSA), and other antibiotic-resistant infections, this has to be balanced against the risk of treatment failure and consequent serious complications with the use of narrower spectrum antibiotics.
Treatment of pain and fever
- Paracetamol is recommended by experts, based on the extrapolation of the effectiveness of paracetamol in the treatment of pain and fever in other conditions [COMPASS, 2007].
- Nonsteroidal anti-inflammatory drugs are generally not recommended by experts, because they are thought to increase the risk of renal impairment in people with acute pyelonephritis [COMPASS, 2007].
Maintenance of full hydration
- This is recommended by experts to maintain a high urine output [COMPASS, 2007], which is believed to help resolve acute pyelonephritis by mechanically flushing the bacteria from the kidney.
Referral for investigation of an underlying risk factor
- Experts recommend investigating people with acute pyelonephritis, especially men, because [Zandi-Nejad and Brown, 2001]:
- Men with acute pyelonephritis are more likely to have an underlying abnormality of renal function or anatomy.
- People with recurrent acute pyelonephritis are more likely to have an underlying abnormality of renal function or anatomy.
- Proteus species is much more common in people with renal calculi.
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