Background:  Pyelonephritis occurs in approximately two per cent of pregnancies and can cause significant maternal and fetal morbidity and mortality. Evidence‐based guidelines recommend appropriate antibiotic therapy, urine culture for test of cure after treatment and monthly follow‐up cultures until delivery.
Aims:  To evaluate adherence to guidelines for the management of antepartum pyelonephritis within an Australian obstetric population and to assess associations with noncompliance.
Methods:  A retrospective study was performed for the 103 pregnant women admitted with pyelonephritis between January 2001 and December 2009 at the Royal Brisbane and Women’s Hospital, a tertiary referral obstetric hospital. We assessed baseline characteristics, the frequency of appropriate treatment and follow‐up, and any associations among these.
Results:  The guideline recommended antibiotic treatment was prescribed in 90.3% of women. Of the women with antibiotic‐resistant organisms, 31.6% had their antibiotics changed appropriately. The test of cure urine culture was performed in only 35.0% of women after treatment completion. Inadequate long‐term follow‐up occurred in 60.2% of the cohort studied. Inappropriate follow‐up was associated with low socioeconomic status (P = 0.04), unemployment (P = 0.04) and the absence of a test of cure urine culture (P = 0.001).
Conclusion:  The empiric treatment of antepartum pyelonephritis is generally appropriate; however, antibiotic changes for bacterial resistance are inadequate. Test of cure and monthly follow‐up urine cultures are infrequently performed despite their recommendation in published treatment guidelines.