Urology Book

Infectious Disease

http://www.fpnotebook.com/

Pyelonephritis in Pregnancy

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  1. See Also
    1. Acute Cystitis in Pregnancy
    2. Urinary Tract Infection
  2. Symptoms
    1. Fever
    2. Chills
    3. Nausea
    4. Contractions
    5. Preterm Labor
    6. Acute Cystitis Symptoms
  3. Signs
    1. Fever
    2. Maternal Tachycardia
    3. Fetal Tachycardia
    4. Costovertebral angle tenderness to palpation
    5. Pelvic exam
  4. Labs
    1. Urinalysis
    2. Urine Culture with Sensitivity
      1. Consider Urinary Catheter sample
    3. Complete Blood Count
      1. Leukocytosis
    4. Chemistry Panel (Chem7)
    5. Strain urine for calculi
  5. Radiology
    1. Renal Ultrasound
      1. Hydronephrosis
    2. Intravenous Pyelogram with 1 image only
  6. Management: Inpatient Antiobiotics
    1. Rocephin 1-2 grams IV or IM every 24 hours
    2. Unasyn 1.5-3g IV q6h
    3. Combination Protocol for 14 days
      1. Ampicillin 2 g IV every 6 hours
      2. Gentamycin 1.5 mg/kg (Maximum 80-100 mg) q8 hours
        1. Adjust dosing per kinetics for >1-2 days use
  7. Management: Other Inpatient Therapy
    1. Bedrest in semi-Fowler's position
      1. Place on side opposite affected kidney
    2. Use cooling measures as needed for Temp > 102
    3. Intravenous hydration
    4. Strain Urine for calculi
    5. Maintain intravenous antibiotics
      1. Oral when affebrile without CVA pain for 48 hours
      2. Complete a total of 7-14 days
      3. Consider Urinary Tract Infection prophylaxis
  8. Management: Outpatient antibiotics
    1. Augmentin 875 mg PO bid for 14 days
    2. Macrodantin (risk of newborn Hemolysis after 38 weeks)
      1. Initial: 100 mg PO qid for 14 days
      2. Prophylaxis: 100 mg PO qhs until 6 weeks postpartum
    3. Keflex 250 mg PO qid for 14 days

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