Acute pyelonephritis is a prevalent bacterial infection affecting the renal pelvis and kidney, predominantly observed in young adult women. Effective diagnosis relies heavily on a thorough patient history and physical examination. Fever is a common symptom, though its absence doesn’t rule out early-stage infection. Flank pain is almost always present, and its absence should prompt consideration of alternative diagnoses.
Urinalysis plays a crucial role in confirming the diagnosis in patients presenting with suggestive history and physical findings. To guide antibiotic therapy, especially in cases unresponsive to initial treatment, urine culture is essential. Escherichia coli is the most frequently identified pathogen in acute pyelonephritis. Alarmingly, there’s been a rise in E. coli resistance to extended-spectrum beta-lactam antibiotics over the past decade.
Medical imaging, typically contrast-enhanced computed tomography, is generally reserved for cases showing no symptom improvement or recurrence after initial treatment success. Most patients can be effectively managed as outpatients. However, inpatient care is recommended for severely ill patients or when complications are suspected.
Clinical practice guidelines suggest oral fluoroquinolones as the first-line outpatient treatment when community fluoroquinolone resistance rates are 10 percent or less. If resistance exceeds this threshold, an initial intravenous dose of ceftriaxone or gentamicin should be administered, followed by an oral fluoroquinolone regimen. Oral beta-lactam antibiotics and trimethoprim/sulfamethoxazole are generally not recommended for outpatient treatment due to high resistance levels. For inpatient management, various antibiotic regimens are effective, including fluoroquinolones, aminoglycosides, and cephalosporins.
In conclusion, prompt diagnosis and appropriate antibiotic treatment, guided by local resistance patterns, are key to effectively managing acute pyelonephritis in women, ensuring favorable patient outcomes.
