Patient handout

Acute pyelonephritis (uncomplicated → complicated)

PRODUCTION

1. Your condition

This handout is for acute pyelonephritis (uncomplicated → complicated). Your care team identified this based on: flank pain + fever.

Other reasons your team may use this plan: costovertebral angle tenderness with systemic symptoms; pyuria/bacteriuria with fever, tachycardia, or rigors.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ciprofloxacin	—	—	—	IDSA/ESCMID 2010 + IDSA 2025: 5-7 d course non-inferior to 10-14 d (CMI 2025 meta-analysis)
levofloxacin	—	—	—	750 mg × 5 d short-course (Peterson 2008)
trimethoprim-sulfamethoxazole	—	—	—	IDSA/ESCMID 2010 — 14 d if susceptible
ceftriaxone	—	—	—	Single 1 g IV/IM bridge before oral; preferred in pregnancy

Plan: Outpatient uncomplicated pyelonephritis

3. When to call your provider

Contact your care team if any of the following happen:

Persistent fever > 72 h on outpatient PO regimen → admit + image (CT/US) for abscess/obstruction (AUA/CUA/SUFU 2019; EAU 2024)
Vomiting / cannot tolerate PO → ED (IDSA 2011 Gupta)
Sepsis features (hypotension, lactate elevation, tachycardia, AMS) → ED + SSC 2026 Hour-1 bundle; routes to id.sepsis.core.v1
Pregnancy with APN → admit (regardless of severity) per IDSA 2011 Gupta + EAU 2024
New AKI (creatinine ≥ 1.5× baseline) → ED + reassess for obstruction; routes to neph.aki.core.v1
Suspected obstruction (new flank pain + fever + hematuria, or hydronephrosis on US) → ED + urgent urology consult (AUA/CUA/SUFU 2019)
Culture growing ESBL / CRE / Pseudomonas with clinical worsening → admit + ID consult; broaden coverage per resistance pattern (EAU 2024)
Kidney transplant recipient with APN → admit + ID consult + transplant-nephrology coordination (regardless of severity) — AST-IDSA transplant ID; EAU 2024

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Pyelonephritis + hypotension on adequate fluids + lactate >2 (SSC 2021; Sepsis-3 2016)(life-threatening)
Hydronephrosis on imaging + pyelonephritis (especially with stone) (AUA/CUA/SUFU 2019; EAU 2024)(life-threatening)
Gas in renal parenchyma on CT (often diabetic) (EAU 2024)(life-threatening)
Acute pyelonephritis in pregnant patient (IDSA 2011 Gupta; NICE 2018 NG109)
Persistent fever or symptoms at 72 h on appropriate antibiotic (AUA/CUA/SUFU 2019; EAU 2024)
Culture-confirmed ESBL- or CRE-producing Enterobacteriaceae pyelonephritis (EAU 2024; IDSA AMR 2024; IDSA 2025 cUTI 4-step framework)
Acute pyelonephritis in kidney transplant recipient — admit regardless of severity (AST-IDSA transplant ID; EAU 2024)

5. Follow-up

Test of cure not routinely needed unless pregnant or relapse; prevention counseling; recurrent UTI workup if ≥2 episodes/year

6. Sources

Guideline: IDSA 2025 Complicated UTI + IDSA/ESCMID 2010 Uncomplicated Pyelonephritis (Gupta CID 2011) + IDSA cUTI 2010 (Hooton) + EAU Urological Infections 2024 + NICE NG109 (2024 review) + SSC 2026 (urosepsis) + AUA/CUA/SUFU 2019 (recurrent UTI / imaging) + KDIGO 2026 (obstructive AKI)