What is the diagnosis and treatment for a male patient with abdominal pain radiating to the back and elevated white blood cell count?

Diagnosis: Acute Pyelonephritis (Kidney Infection)

Based on the clinical presentation of flank pain radiating to the back, elevated WBC (13.4) with neutrophilia (70%), and urinalysis showing pyuria (WBC 3-5) and hematuria (RBC 15-18), this patient has acute pyelonephritis requiring antibiotic treatment.

Medical Assessment

Ang pasyente ay may impeksyon sa bato (acute pyelonephritis) na ipinapakita ng:

• Sakit sa tagiliran na umaabot sa likod (classic symptom ng kidney infection) 1
• Mataas na white blood cell count (13.4, normal: 4-11) na nagpapakita ng infeksyon 2, 1
• Elevated neutrophils (70%) na nagpapahiwatig ng bacterial infection 2
• Urinalysis showing RBC 15-18 at WBC 3-5, confirming urinary tract involvement 3, 4

Ang combination ng flank pain, leukocytosis, at abnormal urinalysis ay highly suggestive ng upper urinary tract infection 3, 4, 5.

Treatment Plan & Medication

Prescribed Antibiotic (PhilHealth Konsulta Formulary):

Amoxicillin 500mg capsule

• Dose: 1 capsule three times daily (every 8 hours)
• Dispense: 21 capsules
• Duration: 7 days
• Cost estimate: Approximately ₱150-200 (within ₱300 budget)

6, 4, 5

Additional Recommendations:

• Maraming tubig (at least 8-10 glasses daily) para i-flush ang bacteria 4
• Kumpletuhin ang 7 days ng antibiotic kahit gumaling na ang sintomas 4, 5
• Bumalik after 3 days kung hindi bumuti o lumalala ang sintomas 3
• Iwasan muna ang alcohol at caffeine 4

Patient Education

Ang kidney infection ay mas seryoso kaysa simple bladder infection. Ang bacteria ay umabot na sa bato kaya kailangan ng mas mahabang treatment. Kung hindi gagamutin ng tama, pwedeng magdulot ng permanent kidney damage o sepsis 6, 5. Kaya mahalaga na kumpletuhin ang lahat ng gamot kahit gumaan na ang pakiramdam.

Warning signs na kailangan bumalik agad:

• Lagnat na 38.5°C o mas mataas 3, 4
• Pagsusuka na hindi makakain 3
• Lumalaking sakit sa tagiliran 3
• Dugo sa ihi na tumataas 4

Medical Certificate

This certifies that patient has been seen and examined today with the diagnosis of: Acute Pyelonephritis (Kidney Infection)

Recommendation: Complete 7-day antibiotic course, increase oral fluid intake, rest, and follow-up in 3 days or sooner if symptoms worsen. Patient is advised to take medical leave from work for 3-5 days to ensure adequate rest and recovery. Patient may return to work after 3 days if symptoms significantly improve and fever resolves, provided work does not involve heavy physical labor.

Fit to work: After completion of at least 3 days of antibiotic therapy and resolution of fever, provided symptoms have significantly improved.

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Clinical Reasoning

The elevated WBC with left shift (neutrophilia 70%) combined with pyuria and hematuria on urinalysis strongly indicates bacterial pyelonephritis rather than simple cystitis 2, 1. The flank pain radiating to the back is the classic presentation of upper urinary tract involvement 3, 4. While fluoroquinolones are preferred for pyelonephritis in many guidelines 6, 5, Amoxicillin remains an acceptable first-line option within the PhilHealth formulary budget constraints, particularly for community-acquired infections where E. coli susceptibility remains reasonable 6, 4.

Critical pitfall to avoid: Do not treat this as simple cystitis with 3-day therapy—pyelonephritis requires minimum 7 days treatment to prevent relapse and renal scarring 6, 4, 5.