Other considerations

Medicines adherence

Medicines adherence may be a problem for some people with medicines that require frequent dosing (for example, some antibiotics) or longer treatment duration (see the NICE guideline on medicines adherence).

Resource implications

  • One small randomised controlled trial (RCT; Moramezi et al. 2008) in pregnant women with acute pyelonephritis found no significant difference in length of hospital stay in women taking a cephalosporin compared with ampicillin plus gentamicin (p=0.22; very low quality evidence).

  • One RCT (Talan et al. 2000), which compared ciprofloxacin with co‑trimoxazole in adult women with acute pyelonephritis, found that resource use (hospital stay, visits and telephone contacts, laboratory tests and prescription costs) was higher in the co‑trimoxazole group (no analysis reported). The only exception was for radiological procedures, which was slightly higher in the ciprofloxacin group (no analysis reported). One systematic review (Eliakim-Raz et al. 2013), which compared antibiotic course lengths in adults with acute pyelonephritis and included the Talan et al. (2000) study, noted a shorter duration of hospital stay with a short course of antibiotics (7 days or fewer) compared with a longer course (10 days to 6 weeks).

  • One RCT in the systematic review by Strohmeier et al. (2014) in children with acute pyelonephritis found that giving sequential intravenous then oral antibiotics reduced the duration of hospital stay compared with a longer duration of intravenous antibiotics (4.9 days compared with 9.8 days).

  • Recommended antibiotics are available as generic formulations, see the Drug Tariff for costs.

  • National Institute for Health and Care Excellence (NICE)