Pyelonephritis
Guidance is for patients 3 months and older.
For patients under 3 months refer to Sepsis under 1 month or Sepsis 1 month and over
Obtain Urine sample for dipstick or microscopy AND culture prior to starting antibiotic therapy.
Take account of previous antibiotic treatment and prior culture results when choosing empiric antimicrobial therapy.
Review antibiotic choice once culture results are known and narrow spectrum of activity if possible.
Review need for IV daily, consider switching to oral therapy at 48-72 hours.
Treat for 7 days.
First Line (including non-severe penicillin allergy)
First choice oral antibiotic: cefalexin 25 mg/kg (Max 1g) po TDS
First choice IV antibiotic: ceftriaxone 80mg/kg (Max 4g) iv OD
When patient tolerates orals: switch to cefalexin 25mg/kg (Max 1g) po TDS
Alternative
For penicillin allergy (severe)
ciprofloxacin* 10mg/kg (max 400mg) iv TDS
When patient tolerates orals: switch to ciprofloxacin* 20mg/kg (max 750mg) po BD
*ciprofloxacin may induce convulsions in patients with or without a history of convulsions – use with caution