Editing Pyelonephritis (section)

===Complicated===
People with acute pyelonephritis that is accompanied by high fever and [[leukocytosis]] are typically admitted to the hospital for intravenous hydration and intravenous antibiotic treatment. Treatment is typically initiated with an intravenous fluoroquinolone, an aminoglycoside, an [[extended-spectrum penicillin]] or cephalosporin, or a [[carbapenem]]. Combination antibiotic therapy is often used in such situations. The treatment regimen is selected based on local resistance data and the susceptibility profile of the specific infecting organism(s).<ref name=Gupta2011/>

During the course of antibiotic treatment, serial white blood cell count and temperature are closely monitored. Typically, the intravenous antibiotics are continued until the person has no fever for at least 24 to 48{{nbsp}}hours, then equivalent antibiotics by mouth can be given for a total of two-week duration of treatment.<ref name=Starlin2005>{{cite book|last1=Cabellon|first1=MCL|editor-last=Starlin|editor-first=R|title=The Washington Manual: Infectious Diseases Subspecialty Consult|edition=1st|chapter=Chapter 8: Urinary Tract Infections|pages=95–108|publisher=Lippincott Williams & Wilkins|location=Philadelphia|year=2005|isbn=978-0-7817-4373-0|chapter-url=https://books.google.com/books?id=DdabV2chPzMC&pg=PA105|url-status=live|archive-url=https://web.archive.org/web/20130527045956/http://books.google.com/books?id=DdabV2chPzMC&lpg=PA105|archive-date=27 May 2013}}</ref> Intravenous fluids may be administered to compensate for the reduced oral intake, insensible losses (due to the raised temperature) and [[vasodilation]] and to optimize urine output. [[Percutaneous nephrostomy]] or ureteral stent placement may be indicated to relieve obstruction caused by a stone. Children with acute pyelonephritis can be treated effectively with oral antibiotics ([[cefixime]], [[ceftibuten]] and [[Augmentin|amoxicillin/clavulanic acid]]) or with short courses (2 to 4{{nbsp}}days) of intravenous therapy followed by oral therapy.<ref name=Strohmeier2014>{{cite journal | vauthors = Strohmeier Y, Hodson EM, Willis NS, Webster AC, Craig JC | title = Antibiotics for acute pyelonephritis in children | journal = The Cochrane Database of Systematic Reviews | volume = 2014 | issue = 7 | pages = CD003772 | date = July 2014 | pmid = 25066627 | pmc = 10580126 | doi = 10.1002/14651858.CD003772.pub4 | hdl-access = free | hdl = 2123/22283 }}</ref> If intravenous therapy is chosen, single daily dosing with aminoglycosides is safe and effective.<ref name=Strohmeier2014/>

Fosfomycin can be used as an efficacious treatment for both UTIs and complicated UTIs including acute pyelonephritis. The standard regimen for complicated UTIs is an oral 3g dose administered once every 48 or 72 hours for a total of 3 doses or a 6 grams every 8 hours for 7 days to 14 days when fosfomycin is given in IV form.<ref name="Zhanel Zhanel Karlowsky 2020 pp. 1–11">{{cite journal | vauthors = Zhanel GG, Zhanel MA, Karlowsky JA | title = Oral and Intravenous Fosfomycin for the Treatment of Complicated Urinary Tract Infections | journal = The Canadian Journal of Infectious Diseases & Medical Microbiology | volume = 2020 | pages = 8513405 | date = 28 March 2020 | pmid = 32300381 | pmc = 7142339 | doi = 10.1155/2020/8513405 | doi-access = free | title-link = doi }}</ref>

Treatment of xanthogranulomatous pyelonephritis involves antibiotics as well as surgery. [[Nephrectomy|Removal of the kidney]] is the best surgical treatment in the overwhelming majority of cases, although polar resection (partial nephrectomy) has been effective for some people with localized disease.<ref name=Korkes2008/><ref name=Rosi1986>{{cite journal | vauthors = Rosi P, Selli C, Carini M, Rosi MF, Mottola A | title = Xanthogranulomatous pyelonephritis: clinical experience with 62 cases | journal = European Urology | volume = 12 | issue = 2 | pages = 96–100 | year = 1986 | pmid = 3956552 | doi = 10.1159/000472589 }}</ref> [[Watchful waiting]] with serial imaging may be appropriate in rare circumstances.<ref name=Lebret2007>{{cite journal | vauthors = Lebret T, Poulain JE, Molinie V, Herve JM, Denoux Y, Guth A, Scherrer A, Botto H | title = Percutaneous core biopsy for renal masses: indications, accuracy and results | journal = The Journal of Urology | volume = 178 | issue = 4 Pt 1 | pages = 1184–8; discussion 1188 | date = October 2007 | pmid = 17698122 | doi = 10.1016/j.juro.2007.05.155 }}</ref>