O23.0
DESCRIPTION
This condition is more serious and may result in preterm labour.
Features of pyelonephritis include:
temperature ≥38ºC
renal angle tenderness (often bilateral)
other features of sepsis, i.e. vomiting, tachypnoea, tachycardia, confusion and hypotension
GENERAL MEASURES
Admit to hospital.
Ensure adequate hydration with intravenous fluids, up to 3 L of sodium chloride 0.9% over 24 hours.
Midstream urine for microscopy, culture and sensitivity.
MEDICINE TREATMENT
Empiric therapy:
- Ceftriaxone, IV, 1 g, daily for 48 hours, or until fever subsides.
OR
- Gentamicin, IV, 6 mg/kg, daily (ensure normal renal function).
Switch to oral therapy as soon as the patient is able to take oral fluids:
- Amoxicillin/clavulanic acid, oral, 875/125 mg 12-hourly for 7 days.
Change antibiotics according to culture and sensitivity results
After treatment, ensure that two urine specimens are negative to confirm eradication.