Acute Pyelonephritis Guidelines

Updated: Jul 01, 2021
  • Author: Tibor Fulop, MD, PhD, FACP, FASN; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Guidelines

Guidelines Summary

The United Kingdom's National Institute for Health and Care Excellence (NICE) has issued guidelines on acute pyelonephritis in children, young people, and adults who do not have a urinary catheter in place. The recommendations cover management, self care, and choice of first-line antibiotic; for second-line therapy, NICE advises consulting with a local microbiologist. [45]

For non-pregnant women and males aged 16 years and over, first-choice oral antibiotics are as follows:

  • Cephalexin
  • Amoxicillin/clavulanate (if culture confirms susceptibility)
  • Trimethoprim (if culture confirms susceptibility)
  • Ciprofloxacin (but consider safety issues; discontinue at the first signs of a serious adverse reaction, including tendon pain or inflammation)

First-choice intravenous (IV) antibiotics (eg, for patients who are vomiting, unable to take oral antibiotics, or severely unwell) are as follows (antibiotics may be combined if susceptibility or sepsis is a concern):

  • Amoxicillin/clavulanate (only in combination, and if culture confirms susceptibility)
  • Cefuroxime
  • Ceftriaxone
  • Ciprofloxacin (but consider safety issues)
  • Gentamicin
  • Amikacin

First-choice antibiotics for pregnant women aged 12 years and over are as follows:

  • Oral: Cephalexin
  • IV: Cefuroxime

For children < 3 months, the NICE guidelines recommend referral to a pediatric specialist for treatment with IV antibiotics. For children > 3 months and adolescents under 16 years of age, first-choice oral antibiotics are as follows:

  • Cephalexin
  • Amoxicillin/clavulanate (if culture confirms susceptibility)

First-choice IV antibiotics for children > 3 months and adolescents under 16 years of age are as follows:

  • Amoxicillin/clavulanate (only in combination, and if culture confirms susceptibility)
  • Cefuroxime
  • Ceftriaxone
  • Gentamicin
  • Amikacin