Pyelonephritis
Alternative names:
acute pyelonephritis; complicated urinary tract infection; infection of the kidney; kidney infection; urinary tract infection - complicated
Treatment:
The goals of treatment are control (cure) of the infection and reduction of symptoms. Acute symptoms usually persist longer than 48 hours after treatment is begun.
Also, due to the high mortality rate in the elderly population, and the risk of permanent kidney damage, prompt treatment is recommended.
Initial therapy usually consists of obtaining a urine culture to identify the causative organism, and selecting appropriate antibiotics to treat that infection. However, it may take 3 to 5 days to receive urine culture results. In the interim, you will usually be hospitalized to receive broad spectrum IV (intravenous) antibiotics and monitoring of kidney function.
MEDICATIONS:
Intravenous (IV) antibiotics may be used initially to control the bacterial infection. In acute cases of pyelonephritis, you will receive a ten to fourteen day course of antibiotics, however, chronic pyelonephritis may require long-term antibiotic therapy. It is imperative that you finish taking the entire course of prescribed antibiotics. Commonly used antibiotics include: - furidantin
- sulfa drugs
- amoxicillin
- cephalosporins
- sulfisoxazole/trimethoprim
- doxycycline
Kidney damage can result from these infections. Also, the elderly, infants, and immunocompromised people are at increased risk for developing sepsis (a severe blood infection). Often, these people will be admitted to the hospital to receive frequent monitoring for potential problems, and to receive IV antibiotics, additional IV fluids and other medications as necessary. In severe cases, a person may be placed in the intensive care unit to receive even more intense monitoring, especially if any cardiac problems are noted.
SURGERY:
Surgery is generally not indicated in the presence of a urinary tract infection.
LIFESTYLE CHANGES:
Preventive measures may reduce symptoms and prevent recurrence of infection. Keeping the genital area clean and remembering to wipe from front to back may reduce the chance of dragging E. coli bacteria from the rectal area to the urethra.
Urinating immediately after sexual intercourse may help eliminate any bacteria that may have been introduced during intercourse. Refraining from urinating for long period of time may allow bacteria time to multiply, so frequent urination may reduce the risk of cystitis in those who are prone to urinary tract infections.
DIET:
Increasing the intake of fluids (2000 to 4000 cc per day) encourages frequent urination that flushes bacteria from the bladder. Avoid fluids that irritate the bladder, such as alcohol, citrus juices, and caffeine.
MONITORING:
Follow-up should include a urine culture at the completion of antibiotic therapy to ensure that bacteria are no longer present in the urine.
Expectations (prognosis):
Most cases of pyelonephritis resolve without complication after the treatment. However, the treatment may need to be aggressive or prolonged.
Complications:
Calling your health care provider:
Call your health care provider if symptoms of pyelonephritis are present.
If you have pyelonephritis, call your health care provider if new symptoms develop, especially decreased urine output, persistent high fever, or severe flank pain or back pain.
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