Monitoring
No monitoring is needed in otherwise healthy patients whose symptoms and signs improve after completion of therapy.
Patients who are pregnant or have multiple medical problems or recurrent urinary tract infections may be candidates for repeat urine cultures after completion of therapy to ensure bacteriologic cure (<1,000 colony-forming units [CFU]/mL) after completing the antibiotic treatment regimen.[10] Imaging studies, such as x-ray, renal ultrasonography, computed tomographic scan, magnetic resonance imaging, and intravenous pyelography, should be repeated as warranted, looking for causes of failed treatment. Careful attention to treatment of underlying medical problems, nutritional parameters, and/or other disease-specific modifying factors (e.g., lithotripsy in the case of renal stones) is essential.
Once clinically improved, pregnant women may be switched to an outpatient course of an oral antimicrobial agent to complete their treatment (usually a 14 day course).[10] Follow-up treatment is important. They should be monitored closely throughout their pregnancy because of an increased risk of recurrent pyelonephritis.[10][62] Prophylactic antimicrobial therapy may be considered to reduce the risk of recurrent pyelonephritis but there is insufficient evidence for clear recommendations on the management after acute treatment of pyelonephritis in pregnancy.[10][62]
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