Management

• management of any urinary tract infection - more prolonged treatment is required than acute cystitis (1)
  
  
• antibiotic prophylaxis is indicated for patients with recurrent urinary tract infections (2)
  
  
• investigation and treatment of underlying cause e.g. obstruction
  
  
• nephrectomy is indicated in unilateral chronic pyelonephritis when the diseased kidney contributes less than 20% of total renal function (3)
  
  

Reference

1. Managing common infections: guidance for primary care. Public Health England, August 2020 - last updated June 2021
2. Garin EH et al. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics. 2006 Mar;117(3):626-32.
3. Soo Park B et al. Outcome of nephrectomy and kidney-preserving procedures for the treatment of emphysematous pyelonephritis. Scand J Urol Nephrol. 2006;40(4):332-8.