From the Guidelines
If left untreated, pyelonephritis can progress to severe complications such as sepsis, shock, and death, emphasizing the importance of prompt diagnosis and treatment. Pyelonephritis is a severe urinary tract infection (UTI) that has the potential to cause significant morbidity and mortality if not properly managed 1. The symptoms of pyelonephritis can range from mild flank pain with low-grade or no fever to septic shock, and up to 20% of patients lack bladder symptoms 1.
Signs and Symptoms
The signs and symptoms of pyelonephritis include:
- Fever
- Flank pain
- Nausea
- Vomiting
- Urinary symptoms like frequent or painful urination
- Chills
- Malaise
- Abdominal pain
Complications
If left untreated, pyelonephritis can lead to complications such as:
- Sepsis
- Kidney abscess
- Chronic kidney disease
- Emphysematous pyelonephritis in diabetic patients
- Perinephric abscess
- Pyonephrosis
Treatment Options
Treatment primarily involves antibiotics, with outpatient options for mild cases including oral fluoroquinolones (ciprofloxacin 500mg twice daily for 7 days), trimethoprim-sulfamethoxazole (160/800mg twice daily for 14 days), or amoxicillin-clavulanate (875/125mg twice daily for 14 days) 1. Severe cases require hospitalization with intravenous antibiotics such as ceftriaxone (1-2g daily), ampicillin plus gentamicin, or piperacillin-tazobactam, typically for 1-2 weeks 1.
High-Risk Patients
High-risk patients, including those with a prior history of pyelonephritis, diabetes, anatomic or congenital abnormalities of the urinary system, and immunosuppressed or immunocompromised patients, require close monitoring and prompt treatment to prevent complications 1.
Prevention
Prevention of pyelonephritis involves proper hygiene and complete antibiotic courses to prevent recurrence, as the infection occurs when bacteria, usually E. coli from the intestinal tract, ascend from the bladder to the kidneys 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Symptoms of Pyelonephritis
- Fever (temperature ≥ 38.5° C) 2
- Flank pain (typically unilateral) 2, 3
- Nausea and vomiting 2, 3
- Costovertebral angle tenderness 2
- Complaints typical of lower UTI may be variably present 2
Complications of Pyelonephritis
- Acute kidney injury 4
- Papillary necrosis 4
- Renal or perinephric abscess 4
- Emphysematous pyelonephritis 4
- Sepsis 5, 2
- Chronic kidney disease (CKD) 6
- If left untreated, pyelonephritis can progress to severe complications, including sepsis and CKD 5, 2, 6
Treatment Options for Pyelonephritis
- Antibiotic therapy should be initiated without delay 2
- Fluoroquinolones and trimethoprim/sulfamethoxazole are effective oral antibiotics in most cases 5
- Parenteral antibiotic therapy is recommended for patients admitted to the hospital 5
- Patients with sepsis or risk of infection with a multidrug-resistant organism should receive antibiotics with activity against extended-spectrum beta-lactamase-producing organisms 5
- Outpatient management is appropriate in patients who have uncomplicated disease and can tolerate oral therapy 5