This guideline sets out an antimicrobial prescribing strategy for acute pyelonephritis (upper urinary tract infection) in children, young people and adults who do not have a catheter. It aims to optimise antibiotic use and reduce antibiotic resistance.
Fluoroquinolone antibiotics: In September 2019, we updated this guideline to reflect MHRA restrictions and precautions for the use of fluoroquinolone antibiotics following rare reports of disabling and potentially long-lasting or irreversible side effects (see the MHRA drug safety update on fluoroquinolone antibiotics and update information for details).
See a 3-page visual summary of the recommendations, including a table to support prescribing decisions.
This guideline includes recommendations on:
- managing acute pyelonephritis, including treatment, reassessment and referral
- choice of antibiotic
Who is it for?
- Health professionals
- People with acute pyelonephritis, their families and carers
Is this guideline up to date?
We checked this guideline in April 2019 to assess the impact of the 2018 English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) report. We found no new evidence that affects the recommendations in this guideline.
Guideline development process
NICE worked with Public Health England to develop this guidance.
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.