This protocol applies to children and young people aged 3 months and over and under 16 years with acute pyelonephritis whose condition has not improved adequately on first-line oral antibiotic therapy, or who are unable to take oral antibiotics.
Children and young people aged 3 months and over and under 16 years presenting with acute pyelonephritis.
First-line treatment involved an oral antibiotic — cefalexin, or co-amoxiclav where culture results permitted. Escalation to this protocol is triggered when symptoms have not started to improve within 48 hours of beginning oral treatment, or when the child is vomiting, severely unwell, or unable to take oral medicines.
Where oral treatment has not achieved the expected response, or cannot be used, intravenous antibiotic therapy is the indicated approach. The choice of agent is guided by clinical severity, susceptibility considerations, and whether sepsis is a concern. If intravenous administration is not possible, an alternative route may be considered. The full antibiotic selection algorithm and review process are in the complete protocol.
Improvement in response to treatment by 48 hours, permitting step-down to oral antibiotics.
Table 3 for children and young people under 16 years.
Review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible for a total of 10 days.
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