Acute pyelonephritis in adults aged 16 and over: next step when first-choice IV antibiotics have not produced improvement by 48 hours

Clinical scenario

This protocol applies to non-pregnant adults aged 16 years and over who have acute pyelonephritis and have been treated with first-choice intravenous antibiotics but have not responded as expected by 48 hours.

Previous treatment — insufficient response

First-choice intravenous antibiotics were given. The treatment goal — sufficient clinical improvement by 48 hours to allow step-down to oral antibiotics — was not reached. This protocol sets out the next step following that failure.

Next-line approach (partial overview)

Second-choice intravenous antibiotic options are indicated at this stage, with local microbiology consultation required in specific circumstances — the full protocol details when and how this applies.

Instant Access to Structured Evidence-Based Regimens

References

table 1 for non-pregnant women and men aged 16 years and over

Consult a local microbiologist

View source ↗