UTI, upper or acute pyelonephritis (pregnant)
Urinalysis is not necessary in suspected pyelonephritis, but when performed is often positive for nitrites, leucocytes and/or protein. Urine culture should be sent irrespective of dipstick result in all women where the diagnosis of pyelonephritis is suspected.
Renal ultrasound should be considered in all pregnant women with confirmed pyelonephritis.
After 24 to 48 hours if clinical improvement consider switching to oral antibiotics, in conjunction with culture results. Total course should be 7 to 10 days.
Treat taking account of:
- severity and frequency of symptoms,
- previous urine culture and susceptibility results,
- previous antibiotic use.
UTI can increase risk of pre-term labour. Do not use co-amoxiclav due to possible increased risk of necrotising enterocolitis in the neonate in patient with pre-labour premature rupture of the membranes.
Preferred including non-severe penicillin allergy
ceftriaxone 2 g iv od
Oral switch: cefalexin 500mg – 1g po tds
Alternative severe penicillin allergy
Consider penicillin allergy assessment and delabelling
gentamicin* 5mg/kg iv. (Gentamicin is for maximum of 3 days). Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.
Oral switch: Discuss with Micro/ID
Additional Information - Gentamicin
*Irreversible vestibular and auditory damage can occur with intravenous gentamicin use, even when serum levels are in range, and certain heritable mitochondrial mutations increase this risk. For more details see Audiometry and intravenous aminoglycosides
Upon initiation ask:
- Is there any hearing problem?
- Is there any family history of deafness or deafness particularly after receiving antibiotics?
If the patient states yes for any of the above discuss with micro/ID for alternative antibiotic. For more details see Audiometry and intravenous aminoglycosides
Reference
- NICE NG111 Pyelonephritis (acute): antimicrobial prescribing October 2018. Available: Overview | Pyelonephritis (acute): antimicrobial prescribing | Guidance | NICE