Pyelonephritis (acute) in non-pregnant women

Pyelonephritis is usually caused by ascent of bacteria, most often Escherichia coli, from the bladder, and is more likely in people with structural or functional urinary tract abnormalities. The prognosis is good if pyelonephritis is treated appropriately, but complications include renal abscess, renal impairment, and septic shock.

We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: antibiotic treatments for acute pyelonephritis in women with uncomplicated infection; inpatient versus outpatient management in women with uncomplicated infection; and analgesia in uncomplicated acute pyelonephritis? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

We found three systematic reviews, RCTs, or observational studies that met our inclusion criteria.

In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics (intravenous), antibiotics (oral), antibiotics (switch therapy), inpatient versus outpatient management, non-steroidal anti-inflammatory drugs, simple analgesics (non-opioid), and urinary analgesics.