Approach to managing acute pyelonephritis in nonpregnant adults

Australian Commission on Safety and Quality in Health Care (ACSQHC), 2023Australian Group on Antimicrobial Resistance (AGAR), 2024Bonkat, 2024National Institute for Health and Care Excellence (NICE), October 2018

For the management of pregnant patients with acute pyelonephritis, see Acute pyelonephritis in pregnancy.

In addition to the factors informing empirical therapy for urinary tract infections (UTIs) described in Approach to empirical antibiotic choice for UTI in adults, empirical therapy for acute pyelonephritis in nonpregnant adults depends on disease severity.

For patients with sepsis or septic shock, see Sepsis and septic shock from a urinary tract source in adults.

For patients who do not have sepsis or septic shock, initial oral antibiotic therapy can usually be used if the patient is able to tolerate and absorb oral therapy. For patients who cannot tolerate or absorb oral therapy, use initial intravenous antibiotic therapy.