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te pyelonephritis
Acute pyelonephritis
P yeloneph ritis is an acute infection of th e renal parench ym a, potentially sev ere,
especially in preg nant w om en, neonates and infants. T h e path og ens causing
pyeloneph ritis are th e sam e as th ose causing cystitis (see pag e 224).
Clinical features
Neonates and infants
– S ym ptom s are not specific: fev er, irritability, v om iting , poor oral intake. P alpation of
th e lower abd om en m ay sh ow abd om inal tend erness. T h e absence of fev er d oes not
rule out th e d iag nosis. O n th e oth er h and , fev er –with no obv ious cause– m ay be th e
only m anifestation.
– N eonates m ay present with fev er or h ypoth erm ia, altered g eneral cond ition, altered
conscious state, pale/g rey colour, sh ock.
In practice, a urinary tract infection sh ould be suspected in ch ild ren with unexplained
fev er or septic synd rom e with no obv ious focus of infection.
Older children and adults
– S ig ns of cystitis (burning on urination and pollakiuria, etc.)
AN D
– Fev er > 38.5°C and flank pain (often unilateral) or abd om inal tend erness
Laboratory
S ee Cystitis pag e 224
Treatment
– Antibiotic th erapy in ch ild ren
• Children under one month
cefotaxime IV : 150 m g /kg /d ay in 3 injections for 10 d ays
or ampicillin IV : 200 m g /kg /d ay in 3 injections for 10 d ays + gentamicin IM or IV :
5 m g /kg once d aily for 5 d ays
• Children over one month
ceftriaxone IM or IV : 50 m g /kg once d aily until th e ch ild 's cond ition im prov es (at
least 3 d ays), th en ch ang e to oral treatm ent with :
amoxicillin/clavulanic acid P O (d ose expressed in am oxicillin):
Ch ild ren < 40 kg : 45 to 50 m g /kg /d ay in 2 d oses (if using ratio 8:1 or 7:1) or in
3 d oses (if using ratio 4:1)
Ch ild ren ≥ 40 kg : 1500 to 2000 m g /d ay in 2 d oses (if using ratio 8:1 or 7:1) or in
3 d oses (if using ratio 4:1)
N ote: th e d ose of clav ulanic acid sh ould not exceed 12.5 m g /kg /d ay or
375 m g /d ay.
226
Acute pyelonephritis
P yeloneph ritis is an acute infection of th e renal parench ym a, potentially sev ere,
especially in preg nant w om en, neonates and infants. T h e path og ens causing
pyeloneph ritis are th e sam e as th ose causing cystitis (see pag e 224).
Clinical features
Neonates and infants
– S ym ptom s are not specific: fev er, irritability, v om iting , poor oral intake. P alpation of
th e lower abd om en m ay sh ow abd om inal tend erness. T h e absence of fev er d oes not
rule out th e d iag nosis. O n th e oth er h and , fev er –with no obv ious cause– m ay be th e
only m anifestation.
– N eonates m ay present with fev er or h ypoth erm ia, altered g eneral cond ition, altered
conscious state, pale/g rey colour, sh ock.
In practice, a urinary tract infection sh ould be suspected in ch ild ren with unexplained
fev er or septic synd rom e with no obv ious focus of infection.
Older children and adults
– S ig ns of cystitis (burning on urination and pollakiuria, etc.)
AN D
– Fev er > 38.5°C and flank pain (often unilateral) or abd om inal tend erness
Laboratory
S ee Cystitis pag e 224
Treatment
– Antibiotic th erapy in ch ild ren
• Children under one month
cefotaxime IV : 150 m g /kg /d ay in 3 injections for 10 d ays
or ampicillin IV : 200 m g /kg /d ay in 3 injections for 10 d ays + gentamicin IM or IV :
5 m g /kg once d aily for 5 d ays
• Children over one month
ceftriaxone IM or IV : 50 m g /kg once d aily until th e ch ild 's cond ition im prov es (at
least 3 d ays), th en ch ang e to oral treatm ent with :
amoxicillin/clavulanic acid P O (d ose expressed in am oxicillin):
Ch ild ren < 40 kg : 45 to 50 m g /kg /d ay in 2 d oses (if using ratio 8:1 or 7:1) or in
3 d oses (if using ratio 4:1)
Ch ild ren ≥ 40 kg : 1500 to 2000 m g /d ay in 2 d oses (if using ratio 8:1 or 7:1) or in
3 d oses (if using ratio 4:1)
N ote: th e d ose of clav ulanic acid sh ould not exceed 12.5 m g /kg /d ay or
375 m g /d ay.
226
