Treatment

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

 

References


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