II. Symptoms

  1. Fever
  2. Chills
  3. Nausea
  4. Contractions
  5. Preterm Labor
  6. Acute Cystitis Symptoms

III. Signs

  1. Fever
  2. Maternal Tachycardia
  3. Fetal Tachycardia
  4. Costovertebral angle tenderness to palpation
  5. Pelvic exam

IV. Labs

  1. Urinalysis
  2. Urine Culture with Sensitivity
    1. Consider Urinary Catheter sample
  3. Complete Blood Count
    1. Leukocytosis
  4. Chemistry Panel (basic metabolic panel)
  5. Consider straining urine for calculi

V. Radiology

VI. Management: Inpatient Antiobiotics

  1. Ceftriaxone (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

VII. 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. 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

VIII. 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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Ontology: pregnancy and pyelonephritis (C0747827)

Concepts Finding (T033)
ICD10 O23.0
English Pyelonephritis in pregnancy, pregnancy pyelonephritis, pregnancy and pyelonephritis, pyelonephritis pregnancy, pregnancy; pyelonephritis
Dutch zwangerschap; pyelonefritis