Educational revision — for learning, not live patient decisions. Guideline-linked. Always work with your seniors and local guidelines.
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● Urgent care clinic · 30-minute consult

Pyelonephritis (well enough for home)

Loin pain and fever — oral treatment if well, admit if not.

Typical consult⏱ 20 min
Investigations🔬 Urine culture; bloods if unwell
Usual outcome💊 Cefalexin 7–10 days
0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document
▶ Practise this consult — work through a case and get a model note
1Rule out first — red flags
If you find……then
Sepsis features, vomiting, unable to take oral fluids/antibioticsAdmit / IV
PregnantDiscuss with obstetrics / medical team — usually admit
Known obstruction, stones, single kidney, or not improvingImaging, urology
Man with pyelonephritisConsider prostatitis / urinary tract abnormality
2What to ask
  • Fever, rigors, loin pain, vomiting
  • Lower UTI symptoms
  • Pregnancy, stones, catheter, recent antibiotics
  • Renal function, allergies
3What to examine
  • Obs (NEWS2)
  • Renal angle tenderness
  • Abdomen
4How to do it — the senior at your shoulder

Lower vs upper UTI

Fever, rigors, loin pain or renal angle tenderness mean the kidney is involved. That needs a longer course and different antibiotics from simple cystitis; nitrofurantoin doesn’t reach the kidney.

5Decide — investigate only if it changes the plan

Home or hospital?

  • Sepsis features (NEWS2 ≥ 5 or a single 3)
  • Vomiting / unable to take oral
  • Pregnant
  • Known obstruction or single kidney

Any present: Admit / IV antibiotics. None present: Oral antibiotics at home with culture and 48 h review.

InvestigationOnly if…
Urine cultureAlways, before antibiotics
Bloods (FBC, U&E, CRP) ± culturesIf unwell or considering admission
6Treat & send home

Management & advice

  • Analgesia, fluids
  • Adjust antibiotics to culture results
  • Review if not improving in 48 h

Refer / follow-up

  • Sepsis, vomiting, pregnant → admit
  • Recurrent / complicated → urology
℞
Discharge prescription (TTO)Typical adult doses. Check allergies, renal function, pregnancy/breastfeeding and interactions. Tap BNF ↗ to confirm.
DrugDoseDuration / notes
Cefalexin BNF ↗500 mg twice or three times a day (up to 1–1.5 g three or four times a day for severe)7–10 days
Co-amoxiclav (only if culture shows susceptibility) BNF ↗500/125 mg three times a day7–10 days
Trimethoprim (only if culture shows susceptibility) BNF ↗200 mg twice a day14 days
Ciprofloxacin (consider safety warnings) BNF ↗500 mg twice a day7 days — MHRA fluoroquinolone warnings: tendon damage, aortic aneurysm, neuropsychiatric effects
Paracetamol BNF ↗1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk)As needed
7Safety-net
Say it like this

You have a kidney infection. You’re well enough to treat at home with antibiotic tablets for 7 to 10 days. Drink plenty and take paracetamol for the pain. If you vomit and can’t keep the tablets down, feel faint or confused, or aren’t getting better within 2 days, come back or call 111 straight away.

Come back / call 111 — or 999 if severe — if:

  • Vomiting and unable to keep tablets down
  • Feeling faint, confused, very unwell, shivering
  • Not improving within 48 h
8Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Kidney infectionnhs.uk/conditions/kidney-infection
Antibiotics — when you need themnhs.uk/conditions/antibiotics
9Where juniors slip up
  • Nitrofurantoin for pyelonephritis
  • No urine culture
  • Sending home a vomiting or septic patient
▶Practise the decision

Revision practice. Work through a real or imagined case to rehearse the reasoning. It builds a model note to learn from. It doesn’t replace your judgement, your seniors or local guidance.

✎Blank clinic note template

Pyelonephritis (well enough for home) — clinic note

URGENT CARE — PYELONEPHRITIS (WELL ENOUGH FOR HOME) PRESENTING COMPLAINT: HISTORY Fever, rigors, loin pain, vomiting: Lower UTI symptoms: Pregnancy, stones, catheter, recent antibiotics: Renal function, allergies: RED FLAGS (record present / absent) [ ] Sepsis features, vomiting, unable to take oral fluids/antibiotics [ ] Pregnant [ ] Known obstruction, stones, single kidney, or not improving [ ] Man with pyelonephritis PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Obs (NEWS2): Renal angle tenderness: Abdomen: DECISION RULE — Home or hospital?: result ______ INVESTIGATIONS: none required / Urine culture, Bloods (FBC, U&E, CRP) ± cultures — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Kidney infection, Antibiotics — when you need them Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Vomiting and unable to keep tablets down - Feeling faint, confused, very unwell, shivering - Not improving within 48 h Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:
✓Guidelines

Doses are typical doses drawn from the guidance above. Always confirm in the current BNF/BNFc and your local antimicrobial policy.

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