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.


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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 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)

Reviewed September 2021

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