Treatment of Acute Pyelonephritis During Pregnancy (Age 12 and Over)

This protocol addresses the management of acute pyelonephritis specifically in pregnant females aged 12 years and over, where both effective antibiotic treatment and patient safety are central considerations.

Clinical scenario: Female patient, pregnant, aged 12 years and over, presenting with acute pyelonephritis.

Treatment approach

When the patient is able to tolerate oral medicines and the clinical severity does not require intravenous treatment, an oral antibiotic is recommended as first-line therapy. Supportive management — including analgesia and ensuring adequate fluid intake — is also part of the approach. The complete antibiotic choice, sequencing, and full management pathway are in the structured protocol.

Treatment goal

Symptoms are expected to start improving within 48 hours of beginning antibiotic therapy.

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References

Table 2 for pregnant women aged 12 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:

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