21.2.1
Pyelonephritis
Malawi Standard Treatment Guidelines, 6th Edition, 2023. Chapter 21, Renal Conditions.
Clinical Description
Acute pyelonephritis is a bacterial infection causing inflammation of the kidneys and is one of the most common diseases of the kidney. Pyelonephritis occurs as a complication of an ascending urinary tract infection (UTI) which spreads from the bladder to the kidneys and their collecting systems
Signs and Symptoms
- Fevers, costovertebral angle pain, nausea, vomiting
Investigations
- Full blood count
- Urine dipstick, microscopy, culture and sensitivity
- Urea, electrolytes and creatinine
- KUB Ultrasound
Pharmacological
- Give Ciprofloxacin 500mg orally 12 hourly for 10-14 days or
- Give Co-amoxiclav 375 mg 8 hourly for 10-14 days
- IV fluids if clinically indicated
Complications and referral criteria: Ongoing pain and fevers despite antibiotic use. Worsening of kidney function.
Alternatively
- Give Gentamycin 240mg IM or IV STAT
- Followed by any of the above oral antibiotics for 10-14 days
- Refer patients with recurrent UTI for further investigations
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