In a pregnant patient with a urinary tract infection complicated by pyelonephritis, what is the recommended management?

• A. Hospital admission with IV antibiotics
• B. Outpatient oral antibiotics
• C. CT abdomen
• D. IV fluids only

Answer: (A)

In pregnancy, pyelonephritis is a potentially life-threatening infection that requires inpatient care with IV antibiotics and close monitoring. Hospital admission ensures rapid, reliable antibiotic delivery and the ability to monitor for sepsis, uterine contractions, and fetal well-being, which are higher risks in pregnant patients. Starting broad-spectrum IV antibiotics that cover common urinary pathogens, along with IV fluids and culture testing, is the safest approach. After the patient improves for 24–48 hours, you can switch to oral antibiotics to complete a total course (typically 10–14 days) and arrange follow-up. CT imaging is avoided in pregnancy due to radiation exposure and is not needed for initial management; IV fluids alone do not treat the infection, and outpatient oral therapy would be unsafe for pyelonephritis in pregnancy.