Patient discussions

If taking antibiotics, patients should follow and complete the regimen so recurrent infection is prevented.

When providing a prescription for antibiotics in the community, give advice about possible adverse effects (particularly diarrhoea and nausea) and when to seek further help.

  • Advise that nausea and vomiting may be an indication of worsening pyelonephritis.

  • Ask the patient to seek medical help if the symptoms worsen or do not begin to improve within 48 hours of starting the antibiotic, or if the patient becomes systemically very unwell.[36]

Advise patients about supportive self-care:[27][36] 

  • Advise patients to drink enough fluids to avoid dehydration (recommendation based on National Institute for Health and Care Excellence [NICE] guideline committee experience)[36]

  • For analgesia, recommend patients take paracetamol and add a weak opioid, such as codeine, if needed (recommendation based on NICE guideline committee opinion).[36] Avoid non-steroidal anti-inflammatory drugs due to the potential risk of acute kidney injury.[36] 

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