Treatment of Acute Pyelonephritis in Adults and Young People Aged 16 and Over (Not Pregnant)
This protocol covers first-line management of acute pyelonephritis in non-pregnant patients aged 16 and over. The treatment pathway is determined by the person's ability to take oral medicines and the severity of their condition.
Patient is 16 years of age or older and is not pregnant. This protocol defines the standard first-line care pathway for this population.
When oral medicines can be tolerated and the severity of the infection does not require intravenous antibiotics, oral antibiotic therapy is the first-line approach. Antibiotic selection depends on clinical suitability and, for certain options, on culture and susceptibility results. Supportive care — including analgesia and adequate fluid intake — is also part of the recommended management. The complete antibiotic choices, selection criteria, and full regimen are in the structured protocol below.
Symptoms should begin to improve within 48 hours of starting antibiotic therapy.
- table 1 for non-pregnant women and men aged 16 years and over
- Give oral antibiotics first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics.
- Advise people with acute pyelonephritis about using paracetamol for pain, with the possible addition of a low-dose weak opioid such as codeine for people over 12 years.
- Advise people with acute pyelonephritis about drinking enough fluids to avoid dehydration.
- Reassess if symptoms worsen at any time, or do not start to improve within 48 hours of taking the antibiotic, taking account of: