Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Management of recurrent pyelonephritis:
- Ensure any acute infection is adequately treated with appropriate antibiotics based on culture and susceptibility results.
- Refer patients, especially children, with recurrent pyelonephritis for specialist assessment and investigations to identify underlying causes.
- Consider a trial of daily antibiotic prophylaxis if behavioural and hygiene measures are insufficient, tailoring antibiotic choice to local resistance patterns and previous sensitivities; preferred agents include trimethoprim and nitrofurantoin (if renal function allows), with cefalexin or amoxicillin as second-line options.
- Advise patients about the risks of long-term antibiotic use, including resistance and adverse effects, and arrange review within 6 months.
- For children, arrange urinary tract imaging such as ultrasound during or shortly after infection and a DMSA scan 4–6 months post-infection to detect renal scarring.
- Encourage behavioural and personal hygiene measures to reduce recurrence risk.
- In women, consider methenamine hippurate as an alternative to daily antibiotic prophylaxis if appropriate and after specialist advice.
Preventive measures:
- Promote adequate hydration and timely voiding to reduce infection risk.
- Manage any underlying conditions such as dysfunctional elimination syndromes or constipation in children.
- Provide education on symptom recognition and prompt treatment seeking for acute UTI symptoms.
- Review and adjust prophylaxis regularly, considering antibiotic rotation and patient preferences.