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In people suspected of having pyelonephritis, a urine culture and antibiotic sensitivity test is performed, so therapy can eventually be tailored on the basis of the infecting organism. [5] As most cases of pyelonephritis are due to bacterial infections, antibiotics are the mainstay of treatment. [5]
For the treatment of simple cystitis in children, a five-day oral course of cephalexin is the preferred choice. As for children with suspected pyelonephritis, a ten-day treatment regimen is recommended. In such cases, a third-generation cephalosporin, such as cefdinir, is suggested as an appropriate option.
In the EU, cefepime/enmetazobactam is indicated for the treatment of complicated urinary tract infections, including pyelonephritis; [2] hospital-acquired pneumonia, including ventilator-associated pneumonia; [2] and the treatment of people with bacteremia that occurs in association with, or is suspected to be associated with, any of the ...
Fosfomycin can be used as an effective treatment for both UTIs and complicated UTIs including acute pyelonephritis. [87] The standard regimen for complicated UTIs is an oral 3g dose administered once every 48 or 72 hours for a total of 3 doses or a 6 grams every 8 hours for 7 days to 14 days when fosfomycin is given in IV form. [87]
When a patient has suspected pyonephrosis, the initial workup should consist of a complete blood count, serum chemistry with blood urea nitrogen (BUN) and creatinine, blood cultures, and urinalysis with culture [6] It is generally not recommended to perform routine radiographic imaging on patients who have simple urinary tract infections.
Murphy's sign has a high sensitivity and negative predictive value, although the specificity is not high. [2] However, in the elderly the sensitivity is markedly lower; a negative Murphy's sign in an elderly person is not useful for ruling out cholecystitis if other tests and the clinical history suggest the diagnosis.
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