This protocol applies to hospitalised patients with acute pyelonephritis whose condition has not responded adequately to first-line empirical parenteral antimicrobial therapy — and who have therefore not been able to transition to oral treatment.
Acute pyelonephritis requiring hospitalisation calls for an intravenous antimicrobial approach. Patients are initially managed with first-line empirical parenteral therapy; those who fail to achieve the expected clinical response require an escalated regimen.
The patient received first-line empirical parenteral antimicrobial therapy — ciprofloxacin, levofloxacin, cefotaxime, or ceftriaxone — without reaching the required goal: clinical improvement and the ability to tolerate oral fluids sufficient to allow a switch from parenteral to oral therapy. Because that threshold was not met, the next treatment line is indicated.
Management escalates to second-line empirical parenteral antimicrobial therapy, incorporating agents with a broader spectrum of activity. The complete agent selection and full dosing regimen are available in the structured protocol below.