The principle and method of acute pyelonephritis

The principle and method of acute pyelonephritis

Control infection

Patients with acute pyelonephritis in a timely manner to choose the appropriate antibiotics, don't wait for the results of urine culture and drug sensitivity test in return, to avoid delaying the disease. General first of gram negative bacilli were sensitive to the antibiotics, because 80% pyelonephritis is caused by the bacterium. Or in the urinary sediment smear, Gram staining after antibiotic selection. The antibacterial spectrum of antibiotics was wide. And the drugs used in the blood and urine have a high concentration, low renal toxicity. 72 hours treatment is invalid (symptoms reduced or no improvement for the other party urine) antibiotics, not frequent dressing.

The use of antibiotics in patients with acute pyelonephritis with enough treatment, generally 10 to 14 days, or subsequent remission of symptoms after 3 - 5 days. Follow up observation should be discontinued once weekly review of urine routine and urine bacterial culture, and bacteria without pyuria can cure that urine after 6 weeks. If the course of treatment is short, the treatment is not thorough, or after stopping the drug does not review, it is possible to relapse or turn into chronic, it is very important to medication and follow-up period.

Two, get rid of susceptible factors

If acute pyelonephritis patients with antibiotics treatment did not improve symptoms, pyuria or bacteriuria does not disappear, and should be actively looking for factors of treatment induced pyelonephritis: predisposing factors. Such as the treatment of urinary tract obstruction, the treatment of chronic diseases, to correct metabolic disorders.

Three, symptomatic treatment

Stay in bed and high calorie, high vitamin diet helps pyelonephritis recovery of patients, it is important to give enough water to flush the urinary tract, encourage more water to maintain adequate urine output. On the urgency, frequent urination, dysuria symptoms, can give belladonna, atropine solution agent or take pain acupuncture therapy (Zusanli, Guan Yuan, or Sanyinjiao), to alleviate the pain and dysuria. Take the sodium bicarbonate alkaline urine, can help relieve dysuria and urinary discomfort.

Western medicine treatment of acute pyelonephritis

For the treatment of acute pyelonephritis from the experience of the long course to a short course, to such a long course of academic development process. A method of therapy for 3 days in a hot or single large dose therapy has been shown to have a relapse and turn for chronic infection the shortcomings of previous treatment principles at home and abroad by the provisions of the "urinary tract infection must have adequate treatment" is widely used to.

1 the general treatment of acute pyelonephritis associated with fever, significant urinary irritation symptoms or hematuria with acute pyelonephritis should rest in bed, the body temperature returned to normal, can significantly reduce the symptoms after get up. General rest 7 to 10 days, the symptoms disappeared completely after the resumption of work. Fever, systemic symptoms, according to the general condition of the patients with liquid or semi liquid diet, no obvious symptoms after changed into normal diet. High fever, digestive tract symptoms can be intravenous fluid. Daily drinking water should be adequate, more water, more urination. So that the urinary tract flushing, to promote the excretion of bacteria and inflammatory secretions, and reduce renal medulla and the high permeability of the nipple, is not conducive to bacterial growth and reproduction.

The diagnosis of pyelonephritis, high fever, headache, back pain to give oral antipyretic, analgesic, urinary irritation symptoms by propantheline bromide (Proulx Ben Sin), anisodamine anticholinergic drugs, urodynia can use sodium bicarbonate and sodium citrate alkaline drugs.

2 antibacterial drugs in the treatment of acute pyelonephritis most acute and severe illness. The treatment should be based on the severity of the symptoms and signs. Before taking the urine specimen for the quantitative culture of bacteria and drug sensitivity report, we should decide the treatment plan according to the doctor's experience. In view of pyelonephritis caused by Gram negative bacteria, it is generally preferred to gram negative bacilli and effective antibiotics, but should be taken into account in the treatment of gram positive bacterial infections.

(1) with mild and moderate severe pyelonephritis caused by acute pyelonephritis: the main bacteria are gram negative bacteria in Escherichia coli, therefore primary acute pyelonephritis can choose effective antibiotics orally for 2 weeks. The commonly used antimicrobial agents for trimethoprim sulfamethoxazole (SMZ), new quinolones, amoxicillin (hydroxyl ampicillin) etc.. Zhongshan Medical University by oral administration of sulfamethoxazole and trimethoprim (SMZ) 1.0g (TMP) 0.2g, 1.0g of sodium bicarbonate, 2 /d, 14 days for 1 courses, the so-called STS therapy, the effect is good. If sulfa allergy can be used amoxicillin 0.5g, 4 /d, or norfloxacin 0.4g, 2 /d, Po, QD for 14 days. In recent years, the new quinolone effect is good, generally 2 to 3 days was not required by the replacement of drug susceptibility results. If no improvement should refer to drug sensitivity test to replace antibiotics. After 14 days of treatment, the negative conversion rate of urine bacteria was about 90%. If the urine bacteria is still positive, should be powerful antibiotics for 4 ~ 6 weeks.

(2) the clinical symptoms of severe pyelonephritis: adopt the intramuscular or intravenous antibiotics. Should be 6 ~ 8g/d or ampicillin, cefotaxime (cefataxime) 6g/d, intravenous drip. When necessary, the combination of the two drugs. Aminoglycoside nephrotoxicity, should be used with caution, the original chronic kidney disease or the elderly should be avoided. After the above treatment, such as improvement in fever continued after medication for 3 days and then changed to oral antibiotics, completed a 2 week course. If not effective, according to the results of drug sensitivity to replace antibiotics. There are complex factors of the pathogen pyelonephritis, multi drug resistance, sometimes in the treatment will be very difficult. According to drug sensitivity can try the following antibiotics:

Netilmicin (netilmicin) 2mg/


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