What is the primary treatment for acute pyelonephritis?

The primary treatment for acute pyelonephritis involves the use of intravenous empiric antibiotics, which often includes aminoglycosides, and once the patient stabilizes, transitioning to oral antibiotics such as fluoroquinolones. This approach is crucial as acute pyelonephritis, an infection of the kidney, can manifest with severe symptoms and potential complications, thus requiring prompt and effective treatment.

Intravenous administration of antibiotics ensures high bioavailability and immediate drug action, especially in a patient who may be experiencing severe symptoms or has complications such as nausea or vomiting, which could prevent effective oral medication absorption. Once improvement is noted and criteria for transition are met, moving to oral therapy allows for continued treatment while facilitating outpatient management.

This strategy not only provides a robust framework for controlling the infection but also tailors the treatment based on patient stability and resistance patterns, which is critical in managing urinary tract infections effectively. It's important to note that while hydration is important in the overall management of patients with pyelonephritis, IV hydration alone would not address the underlying infection. Watchful waiting is not appropriate for acute pyelonephritis since timely antibiotic intervention is essential to prevent further complications, such as renal abscess formation or sepsis.