Clinical protocol for pyelonephritis
CLINICAL PROTOCOL FOR PYELONEPHRITIS
hospital admission or complex medical co-
morbidities eg poorly controlled diabetes
and/or renal failure). Particularly in age
assessed as stable, has a clear diagnosis
penicillin or cephalosporin hypersensitivity
and prognosis and is at a low risk of rapid
Evidence of impending septic shock (Temp < 35 or > 38.5°C systolic BP <90 and/or diastolic BP <60 HR >125/min >30 per min.
Previous treated UTI – not responsive to antibiotics (example pseudomonas infections).
Known renal tract abnormalities (eg long term in-dwelling catheter/supra- pubic catheter, ureteric stents obstructive uropathy.
Mid stream urine MC&S (prior to antibiotics if possible).
Blood for urea and electrolytes, if requested by medical governance doctor.
SUGGESTED ANTIBIOTIC REGIMEN
Suggested antibiotic regimen for mild infections
Amoxicillin + Clavulanate 875 + 125 mg, orally BD, 14 days
If causative organism is Pseudomonas Aeruginosa
use Ciprofloxacin 500 mg 12 hourly orally for 14 days (contraindicated in pregnancy).
Suggested antibiotic regimen for moderate/severe infections
Gentamicin 5mg/kg intravenous daily (maximum three (3) days).
Continue treatment for a total of 10 – 14 days, the greater part of which may be on oral
If unusual or multi-resistant organism consult a Clinical Microbiologist/Infectious Diseases Physician.
Clinical Protocol for Pyelonephritis
Urine MC&S should be completed prior to the commencement of antibiotic therapy.
Collaborate with medical governance Doctor regarding abnormal results.
Commence intravenous therapy if prescribed.
Advise client re oral fluid intake >2 litres per day.
Assess post void residual volumes with bladder scanner.
Nursing assessments per Pyelonephritis Assessment Tool report to medical governance any deterioration in client condition.
If loin pain and temperature continue for 3 days refer back to medical governance doctor.
Clinical improvement – start oral therapy, resolution of fever, loin pain
Clinical deterioration – admit to hospital if:
Systemic deterioration, including elevated temperature, elevated pulse
Hypotension/hypertension (outside client’s normal parameters).
Symptoms suggestive of renal colic/calculi, which are unmanageable at home.
Renal tract ultrasound in all men will Pyelonephritis and women with recurrent infections or suspected abnormal renal tract.
With client’s General Practitioner appointment made prior to HATH discharge.
Client has access to medical governance support twenty four (24) hours per day, seven (7) days a
week. Care delivery is planned and provided in consultation with the client, medical
officer/specialist holding medical governance and nursing staff. Medical specialists may retain
medical governance with treatment interventions delivered by Silver Chain. When governance is
retained by a Silver Chain medical officer the client will have a medical review within twenty four
(24) hours of admission and scheduled follow-up up as determined by the medical officer for that
individual client. In the instance when a client’s condition deteriorates the Silver Chain medical
officer or nursing staff will confer with an emergency department medical officer. All Silver Chain
medical officers are formally credentialed. Silver Chain’s medical officer holding governance wil
determine when the client can be discharged and a summary is sent to the referrer or client’s
general practitioner. REFERENCE
Therapeutic Guidelines Antibiotic Version 13, 2006. Therapeutic Guidelines Ltd Melbourne.
Monitoring of clinical and laboratory data in two casesHerbert Schmitz a,*, Bernhard Köhler b, Thomas Laue c, Christian Drosten a,Peter J. Veldkamp d, Stephan Günther a, Petra Emmerich a, Hans P. Geisen e,Klaus Fleischer b, Matthias F.C. Beersma d, Achim Hoerauf fa Department of Virology, Bernhard-Nocht-Institute for Tropical Medicine, Bernhard-Nocht-Str.74, 20359 Hamburg, Germany b Mission
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