Acute pyelonephritis

Mild cases can be treated with oral therapy alone using double the dosage of drugs recommended for uncomplicated cystitis, except for trimethoprim when the same dosage is recommended. Norfloxacin (400 mg (o) 12 hourly) is used if resistance to these drugs is proven.

For severe infection with suspected septicaemia admit to hospital and treat initially with parenteral antibiotics for 2 to 5 days after taking urine for microscopy and culture and blood for culture. amoxycillin 2 g IV 6 hourly 5 plus gentamicin 5-7 mg/kg/day, single daily dose

Follow with oral therapy for a total of 14 days therapy. Drug levels of gentamicin require monitoring.

Gentamicin can be replaced with IV cefotaxime or ceftriaxone if desired.

All patients should be investigated for an underlying urinary tract abnormality.

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