Acute Pyelonephritis

Comments from the Expert Advisory Committee

Send MSU for culture and sensitivity in all cases prior to the patient starting the antibiotic.

Consider acute pyelonephritis/ upper UTI when:

• Pain in the loin which radiates to the iliac fossa and suprapubic area.
• Sudden onset general systemic disturbance with fever, rigors, vomiting.
• Tenderness and guarding over the kidney.

Consider referring to hospital if:

• Patient is significantly dehydrated or unable to take oral fluids and medicines.
• Child/ young person <16 with acute pyelonephritis.
• Aged 16 years and over with acute pyelonephritis and have a severe systemic infection.
• Patient is pregnant.
• Patient has a higher risk of developing complications (e.g. people with known or suspected structural or functional abnormality of the genitourinary tract or underlying disease [such as diabetes or immunosuppression]).

Nitrofurantoin is NOT a suitable antibiotic choice in pyelonephritis.

Treatment

Patient Information

Visit HPSC Information Leaflets pages for the General Public, (MRSA, CRE, etc)

We recommend patients use the website developed by HSE/ICGP/IPU partnership www.undertheweather.ie for tips on how to get better from common infections without using antibiotics, what you can do for yourself or a loved one and when to seek help.

Safe Prescribing (visit the safe prescribing page)

• Doses are oral and for adults unless otherwise stated
• Dosing in children quick reference dosage/weight guide
• Fluoroquinolone warning
• Penicillin allergy – tips on prescribing in penicillin allergy
• Renal impairment dosing table
• Safety in Pregnancy and Lactation
• Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.

Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed September 2021