• Common signs and symptoms include acute-onset fever, chills, severe back or flank pain, nausea and vomiting, and costovertebral angle tenderness.
  • Urinalysis and urine culture confirm the diagnosis of pyelonephritis. Urine cultures, obtained prior to treatment, demonstrate bacteria, most often Escherichia coli.
  • The route and choice of empiric antibiotics depend on the severity of illness and the presumed bacterial sensitivities pending culture results.
  • Complications most often result from inappropriate (wrong drug or wrong dose) antibiotic use or antibiotic resistance, leading to recurrent or progressive infection.
  • Other common causes of complications are inadequate treatment of anatomic abnormalities (e.g., kidney stones or obstruction), preventing bacterial clearance.

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