Treatment of Acute Pyelonephritis Not Requiring Hospitalisation

Clinical Scenario

This protocol addresses the management of acute pyelonephritis in patients who do not require hospital admission, allowing treatment to be completed on an outpatient basis with oral antimicrobial therapy.

Treatment Approach

First-line oral therapy centres on a short course of fluoroquinolones — provided local resistance rates satisfy a defined threshold. Where fluoroquinolones are not appropriate, alternative oral regimens are available, though the choice of agent may determine whether an initial parenteral dose is also required.

The specific agents, durations, resistance criteria, and contraindicated options are detailed in the full protocol →

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References

Treat patients with pyelonephritis not requiring hospitalisation with short course fluoroquinolones as first-line treatment.
Fluoroquinolone resistance should be less than 10%.
If such agents are used empirically, an initial intravenous dose of a long-acting parenteral antimicrobial (e.g. ceftriaxone) should be administered.
Do not use nitrofurantoin, oral fosfomycin and pivmecillinam to treat pyelonephritis.

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