Acute Pyelonephritis in Adults Aged 16 and Over: Next Step After Oral Antibiotics Have Not Improved Symptoms Within 48 Hours
This protocol applies to adults aged 16 years and over who are not pregnant and whose clinical condition requires intravenous treatment — including those who cannot take oral medicines, are vomiting, or are severely unwell.
Previous treatment & escalation trigger
First-line oral antibiotic therapy is typically prescribed when the patient can take oral medicines and the severity does not require intravenous treatment. This protocol is the appropriate next step when symptoms have not begun to improve within 48 hours of starting oral antibiotics, or when the patient's condition precludes the oral route.
Treatment approach
Intravenous antibiotic therapy forms the basis of management in this scenario, with a structured clinical review at 48 hours to assess response and determine whether step-down to oral antibiotics is appropriate.
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Clinical goal: improvement in response to treatment by 48 hours, allowing step-down to oral antibiotics.
References
- table 1 for non-pregnant women and men aged 16 years and over
- Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible.
- For intravenous treatment, antibiotics should be reviewed by 48 hours and stepped down to oral antibiotics where possible, for a total of 7 days.