Acute uncomplicated pyelonephritis is a bacterial kidney infection. It is more frequent in women than in men and is generally caused by the Escherichia coli bacterium. Pyelonephritis is suspected in cases of spontaneous lumbar pain or tenderness during palpation, combined with a high fever, shivering, nausea and vomiting and often urinary disorders such as frequent and painful urination, pelvic pains or a feeling of heaviness, presence of blood in the urine.

A urine sample should be taken for culture and to test sensitivity to antibiotics rather than starting an antibiotic treatment without waiting for the result.

Acute uncomplicated pyelonephritis can generally be treated with a 7-day course of an oral antibiotic at home, and clears up quickly.

In 2014, in France, despite a growing risk of resistance, an oral fluoroquinolone such as ciprofloxacin or ofloxacin is the first-choice antibiotic. When a patient has already received a quinolone treatment in the previous three months, or has just been hospitalised, there is a high risk of resistance to fluoroquinolones: then injectable ceftriaxone, a 3rd-generation cephalosporin, is preferable.

The level of resistance to antibiotics is probably lower in the community than in hospital.

It is best to avoid, as far as possible, prescribing fluoroquinolones and cephalosporins in the case of common urinary infections such as uncomplicated cystitis, as this will help curb bacterial resistance to these antibiotics.

©Prescrire 1 December 2014

"Antibiotic therapy for acute uncomplicated pyelonephritis in women" Prescrire Int 2014; 23 (155): 296-300. (Pdf, subscribers only).