(4) Treatment of acute pyelonephritis. Antibiotic therapy is the center of
treatment. Start treatment after the specific infecting organism has been identified from
culture and sensitivity studies of the patient's urine. Follow this treatment:
(a) Give antibiotics after urinalysis and culture and sensitivity tests
have been performed.
(b) Continue antibiotics for 10 to 14 days. Inform the patient that urine
usually becomes sterile in from 48 to 72 hours after he starts taking antibiotics.
However, stress the importance of continuing the course of treatment for the full number
of days the treatment has been prescribed.
(c) Encourage a fluid intake sufficient to achieve urinary output of more
than 2,000 ml per day. While intake of fluid is important, the patient must take care not
to consume too much fluid. Two to three liters of fluid should be the limit of fluid
consumed by the patient. Intake of more than two or three liters of fluid may decrease
the effectiveness of the antibiotics.
(d) Control fever through antipyretics (medication that reduces or
Teach patients with a history of urinary tract infections to recognize the signs
of infection such as cloudy urine, burning on urination, frequency, and
urgency. Early recognition of signs of a possible infection means that the
patient can seek early treatment thus preventing severe infection.
b. Chronic Pyelonephritis. This type of pyelonephritis is a persistent infection
that can scar the kidneys and may lead to chronic renal failure. This more serious
disease is frequently seen in patients with urinary tract blockage. Persistent or repeated
bacterial infections may cause chronic pyelonephritis. This disease can be effectively
treated with antimicrobial medication. It is very important to prevent this infection.
Preventive measures include avoiding catheterization and instrumentation and
practicing good hygiene.
Hydronephrosis is distention of the renal pelvis and calyces caused by an
accumulation of urine caused by an obstruction to the normal urine flow. The obstruction
may occur at any level in the urinary tract.