Acute uncomplicated pyelonephritis
- 2-week course of appropriate oral antibiotics (trimethoprim-sulfamethoxasole or fluoroquinolones).
- For patients who are vomiting and dehydrated, septic, or with complicated pyelonephritis
- Intravenous hydration and antibiotic therapy (a penicillin and an aminoglycoside, substituting vancomycin in penicillinallergic patients).
- Cephalosporins (recommended for pregnant patients).
- Convert to appropriate oral antibiotics (once clinically stable).
- Duration of antibiotic treatment for complicated pyelonephritis is 3 weeks.
- Narcotic analgesics, nonsteroidal antiinflammatory drugs, and antiemetics (for pain and nausea)
- Patients promptly responding to therapy should undergo subsequent evaluation for urinary obstruction, calculi, or other factors, with intravenous urography and/or ultrasonography.
Chronic pyelonephritis
- Surgical treatment, occasionally in conjunction with;
- Appropriate urinary antiseptics (penicillin, nitrofurantoin, or trimethoprim-sulfamethoxisole).
- Urease inhibitors (acetohydroxaminic acid).
- Nephrectomy
Special Case: XANTHOGRANULOMATOUS PYELONEPHRITIS (XGP)
Treatment
- XGP is usually treated with nephrectomy.
Complications
Renal Abscess
May follow insufficient treatment of focal bacterial nephritis (lobar nephronia).
Treatment
- Percutaneous aspiration and prolonged antimicrobial therapy or definitive surgical drainage
Perinephric Abscess
Treatment
- Similar to treatment for renal abscess
Emphysematous Pyelonephritis
Treatment
- Immediate nephrectomy in combination with appropriate antibiotics
- Aggressive percutaneous renal and perirenal drainage