Pyelonephritis In Children

Acute pyelonephritis is bacterial infection involving the renal parenchyma and collecting system.

It represents an upper urinary tract infection and carries greater risk of systemic illness and renal injury than isolated cystitis.

• High fever
• Chills
• Vomiting
• Abdominal or flank pain
• Costovertebral angle tenderness
• Malaise
• Dysuria or frequency may coexist

Infants frequently lack localizing urinary symptoms.

• Urinalysis
• Urine microscopy and culture
• FBC and inflammatory markers in significant illness
• Blood culture in young infants or septic children
• Renal function and electrolytes in severe disease

Renal ultrasound is particularly appropriate for atypical infection, poor response, recurrent pyelonephritis or suspected obstruction.

A stable child able to tolerate oral treatment can often be managed orally.

A commonly used option is:

Cefalexin 25 mg/kg PO per dose every 8 hours, maximum according to local formulary, for approximately 7 to 10 days.

Severe illness may require:

Ceftriaxone 50 to 75 mg/kg IV once daily, maximum 2 g/day for routine infection, adjusted according to clinical context and local protocols.

Avoid ceftriaxone in neonates where bilirubin displacement or calcium containing IV solutions are concerns.

Switch from IV to oral treatment when the child is clinically improving and tolerating oral medication.