Acute Pyelonephritis in Pregnancy: What to Do When Oral Antibiotics Have Not Worked
This protocol addresses acute pyelonephritis in pregnant women aged 12 years and over whose symptoms have not improved within 48 hours of starting oral antibiotic therapy, or who are unable to tolerate oral medication or are severely unwell.
Female patient; pregnant; aged 12 years and over presenting with acute pyelonephritis.
First-line management uses a first-choice oral antibiotic (cefalexin) when the patient can take oral medicines and does not require intravenous therapy. Escalation to this protocol is indicated when symptoms do not start to improve within 48 hours of beginning that oral regimen, or when the patient is vomiting, unable to take oral antibiotics, or severely unwell.
When the oral antibiotic approach has not produced the expected early improvement, the protocol moves to a first-choice intravenous antibiotic. The full regimen, including structured reassessment criteria, is set out in the complete protocol.
Goal: improvement by 48 hours, enabling step-down to oral antibioticsReferences
- table 2 for pregnant women aged 12 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.