Acute pyelonephritis
ICD-10 N10 · ICD-11 GB51

Acute Pyelonephritis in Pregnancy: What to Do When First-Line IV Antibiotics Have Not Worked

Clinical scenario

This protocol applies to pregnant female patients aged 12 years and over with acute pyelonephritis who have been started on a first-choice intravenous antibiotic but have not achieved the expected response by 48 hours.

Patient population

Female patients who are pregnant, aged 12 years and over. Pregnancy requires particular attention when selecting antibiotic therapy, especially once first-line treatment has not delivered the anticipated clinical progress.

Previous treatment — failure condition

The prior step was the first-choice intravenous antibiotic (Cefuroxime). The required goal — improvement in response to treatment by 48 hours, sufficient to allow step-down to oral antibiotics — was not achieved. This protocol describes the next step taken after that failure.

Next-step approach (partial)

When the first-choice intravenous antibiotic has not produced the expected response, the approach moves to second-choice antibiotics, or to combination antibiotic therapy where susceptibility or sepsis is a concern — with specialist input required for selection. The complete structured regimen is in the full protocol.

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References

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