Acute Pyelonephritis or UTI with Systemic Sepsis

Micro-organism

E.Coli

First Line

< 3 months old - Cefotaxime IV  +/- gentamicin IV  if further deterioration or no improvement for 7-10 days

> 3 months old - Ceftriaxone IV +/- gentamicin IV  if further deterioration or no improvement for 7-10 days

Consider alternative antibiotic if temperature not settling after 48 hours

Switch to oral antibiotics once clinically improved.  Use C+S to guide choice. Nitrofurantoin is not suitable for the treatment of acute pyelonephritis or as an oral switch from IV treatment

Anaphylaxis (including severe skin reactions) to penicillin / cephalosporin

Vancomycin IV + Gentamicin IV for 7-10 days

Notes

Nitrofurantoin is not suitable as an oral switch for the treatment of acute pyelonephritis or systemic sepsis

Link to NICE Guideline

CKS - UTI in children