A. Women with acute uncomplicated pyelonephritis may present with a mild cystitis-like illness and flank pain; fever, chills, nausea, vomiting, leukocytosis and abdominal pain; or a serious gram-negative bacteremia. Uncomplicated pyelonephritis is usually caused by E. coli.
B. The diagnosis should be confirmed by urinalysis and by urine culture. Urine cultures demonstrate more than 100,000 CFU per mL of urine in 80 percent of women with pyelonephritis. Blood cultures are positive in up to 20 percent of women who have this infection.
C. Empiric therapy using an oral fluoroquinolone is recommended in women with mild to moderate symptoms. Patients who are too ill to take oral antibiotics should initially be treated with a parenterally third-generation cephalosporin, aztreonam, a broad-spectrum penicillin, a quinolone or an aminoglycoside.
D. The total duration of therapy is usually 14 days. Patients with persistent symptoms after three days of antimicrobial therapy should be evaluated by renal ultrasonography for evidence of urinary obstruction or abscess.
References: See page 184.
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