Patient handout

Acute pyelonephritis (upper UTI; outpatient + inpatient + complicated + urosepsis)

PRODUCTION

1. Your condition

This handout is for acute pyelonephritis (upper uti; outpatient + inpatient + complicated + urosepsis). Your care team identified this based on: fever + flank pain ± n/v ± dysuria — classic acute pyelonephritis (idsa 2010 gupta pmid 21292654).

Other reasons your team may use this plan: costovertebral angle tenderness on exam (idsa 2010); dysuria + fever — pyelo concern over cystitis (idsa 2010); hypotension + fever + flank pain / dysuria — urosepsis (scc 2026).

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	500 mg PO BID	PO	BID × 7 days	IDSA 2010 outpatient first-line if local R <10%; reserve in elderly per FDA Black Box for tendinopathy / aortic / CNS / dysglycemia (Gupta PMID 21292654)
levofloxacin	750 mg PO daily	PO	once daily × 5 days	IDSA 2010 outpatient alternative — 5-day high-dose comparable to 7-day cipro (Gupta PMID 21292654)

Plan: Acute pyelonephritis — IDSA 2010 outpatient + inpatient empiric + ESBL escalation + pregnancy regimen + Pseudomonas coverage

3. When to call your provider

Contact your care team if any of the following happen:

Treatment failure at 48–72 h → admit (IDSA 2010)
Worsening symptoms / new red flags → ED (SCC 2026)
Recurrent pyelo → urology referral for anatomic workup (AUA 2016)

4. When to seek emergency care

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

Severe symptoms, vomiting, ill-appearing, cannot tolerate PO, age >60 + comorbidities — admit (IDSA 2010)
Obstruction, immunocompromise, anatomic anomaly, pregnancy, men, recurrent, transplant — complicated phenotype (IDSA 2010; EAU 2020)
Pyelo + sepsis (qSOFA ≥2 or hypotension) + obstruction on imaging — STAT decompression emergency (SCC 2026; AUA 2016; EAU 2020)(life-threatening)
Diabetic patient with gas in renal parenchyma on CT — emphysematous pyelo; high mortality without source control (EAU 2020)(life-threatening)
Renal or perinephric abscess on CT or US — drainage indicated + 4–6 wk culture-directed antibiotics (EAU 2020)
Pregnant patient with pyelo — admit; IV ceftriaxone; AVOID FQ throughout (cartilage); fetal monitoring (USPSTF 2019; IDSA 2010)
XGP — chronic destructive pyelo with obstruction + staghorn calculi; renal mass on CT (bear-paw sign); nephrectomy often required (EAU 2020)
Prior ESBL E. coli / Klebsiella culture OR healthcare-associated risk factors → ertapenem 1 g IV q24h; tailored if CRE (Tamma 2019)

5. Follow-up

Outpatient urology if obstruction / recurrent; pregnancy → repeat culture at 1–2 wk; counsel recurrent pyelo prevention; recurrent breakthrough → urology workup (IDSA 2010; AUA 2022)

6. Sources

Guideline: IDSA 2011 Acute Uncomplicated Cystitis/Pyelonephritis (Gupta) + Hooton NEJM 2012 uncomplicated-UTI review + IDSA 2020 ESBL/CRE (Tamma — ertapenem for ESBL pyelo) + fluoroquinolone disabling-ADR evidence (FDA safety review) + SCC 2026 sepsis bundle (urosepsis pathway)