Clinical protocol for pyelonephritis

CLINICAL PROTOCOL FOR PYELONEPHRITIS
Inclusion Criteria
Exclusion Criteria
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.
PATHOLOGY WORK-UP

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Mid stream urine MC&S (prior to antibiotics if possible). Blood for urea and electrolytes, if requested by medical governance doctor.
SUGGESTED ANTIBIOTIC REGIMEN

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Suggested antibiotic regimen for mild infections
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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
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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
TREATMENT

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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.
FOLLOW UP
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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.
MEDICAL GOVERNANCE
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.

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