Pyelonephritis is usually caused by ascent of bacteria, most often Escherichia coli, from the bladder, and is more likely in people with structural or functional urinary tract abnormalities. The prognosis is good if pyelonephritis is treated appropriately, but complications include renal abscess, renal impairment, and septic shock.
Methods and outcomes
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: oral antibiotic treatments for acute pyelonephritis in women with uncomplicated infection; antibiotic treatments in women admitted to hospital with complicated infection; inpatient versus outpatient management in women with uncomplicated infection; analgesia in uncomplicated acute pyelonephritis? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 5 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: analgesics, inpatient management, intravenous antibiotics, non-opioids, non-steroidal anti-inflammatory drugs, oral antibiotics, outpatient management, urinary analgesics.
Pyelonephritis is usually caused by ascent of bacteria from the bladder, most often Escherichia coli, and is more likely in people with structural or functional urinary tract abnormalities.
The prognosis is good if pyelonephritis is treated appropriately, but complications include renal abscess, renal impairment, and septic shock.
Consensus is that oral antibiotics, given in the outpatient setting, are effective in non-pregnant women with uncomplicated pyelonephritis, although no placebo-controlled studies have been found.
We don't know whether any one treatment regimen is more effective, or what the optimum duration of treatment is, although it may be sensible to continue treatment for at least 10 days.Broader spectrum antibiotics, such as quinolones, may be more effective compared with narrower spectrum antibiotics, such as ampicillin, amoxicillin, or co-trimoxazole, in areas where resistance to these is common.In the outpatient setting, we don't know whether intravenous antibiotics are more effective in non-pregnant women with uncomplicated pyelonephritis compared with oral regimens.
Intravenous antibiotics are considered effective in women admitted to hospital with uncomplicated pyelonephritis.
We don't know which is the most effective intravenous antibiotic regimen, or the optimum duration of treatment.Combining intravenous plus oral antibiotics may be no more effective that oral antibiotics alone, but the evidence is weak.
We don't know whether inpatient treatment improves outcomes compared with outpatient treatment.
We found no evidence that simple analgesics ,NSAIDs, or urinary analgesics reduce pain from uncomplicated pyelonephritis.
NSAIDs may worsen renal function and should be used in caution in women with pyelonephritis.