What is the treatment and follow-up of acute pyelonephritis in pediatric urinary tract infection (UTI)?

Updated: Mar 19, 2019
  • Author: Donna J Fisher, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

A Cochrane review concluded that children with acute pyelonephritis can be treated effectively with either oral antibiotics or with 2-4 days of IV therapy followed by oral therapy. [44] Similarly, a study by Hoberman et al indicated that oral therapy with a third-generation cephalosporin was as effective as traditional inpatient parenteral treatment. [45]

For parenteral therapy in a patient who is not allergic to cephalosporins, initial treatment may consist of a single dose of ceftriaxone (75 mg/kg IV/IM q12-24h). If the patient has cephalosporin allergy, initial treatment may be with gentamicin (2.5 mg/kg IV/IM as a single dose). Patients who demonstrate a satisfactory response can be switched to an oral antibacterial agent at therapeutic doses within the next 12-18 hours.

Arrange for a follow-up (which is usually performed by telephone) at 24 hours to monitor the patient's response to treatment and at 48 hours to modify treatment if the results of antibacterial sensitivity studies indicate a need to change. Arrange for a follow-up visit after 7-10 days to check the patient's clinical course.


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