acute pyelonephritis

Question 1

why we give antibiotic treatment throughout the pregnancy ?

Answer 1

as prophylactic to pyelonephritis

Question 2

acute pyelonephritis ?

Answer 2

bacterial infection of upper urinary tract that usually develops from lower UTI
** fever ,flank pain

Question 3

treatment : in pregnancy

Answer 3

nitrofurantoin
amoxicillin
ceftriaxone

CI : fluoroquinolones
tetracycline
tmx-sms

Question 4

Pathogenesis

Answer 4

Certain anatomic changes that occur during pregnancy predispose
pregnant women to pyelonephritis, including increased stasis of the
urine in the urinary tract due to smooth muscle relaxation in the
ureters

Question 5

Prevention

Answer 5

Acute pyelonephritis is best prevented by screening for and treating
asymptomatic bacteruria.

Question 6

Obstetrical complications

Answer 6

1. preterm labor
2. fetal death
3. intrauterine growth restriction

Question 7

Treatment

Answer 7

**A first-generation cephalosporin such as cefazolin 1 g parenterally
every 8 hours usually is effective.

** Ceftriaxone 1 g
parenterally every 24 hours often is effective for most
Enterobacteriaceae (if first generation didn’t work)

**When the patient is afebrile for 48 hours, switch to oral antibiotic (total course of 14 days )

Question 8

If no clinical response is seen in 48–72 hours,(fever continues)

Answer 8

adding an
aminoglycoside such as gentamicin 3–5 mg/kg per 24 hours in 3
divided doses given every 8 hours.

Question 9

If no clinical response is seen after gentamicin ,What next?

Answer 9

ultrasound to check for kidney congenital defects
or nephrolithiasis or perinephric abscess

Question 10

if perinephric abscess developed …treatment ?

Answer 10

percutaneous drainage