Clinical Trial Comparing Oral Versus Intravenous Cefuroxime in Pregnant Women with Pyelonephritis

Inclusion Criteria:

• Pregnant women aged 18 years or older and less than 20 weeks of gestational age,determined by ultrasound or the date of last menstruation, who come to the HCPAemergency department with a clinical diagnosis of pyelonephritis in pregnancy,defined as:

• Presence of lower back pain associated with

• Dysuria with leukocyturia, or hematuria or nitrite in the urine test with at leastone of the criteria below:

• Leukocytosis (> 14,000 leukocytes/mL)

• Warm extremities, thready pulse, and tachycardia (HR > 110 bpm)

• Cyanosis and/or pallor

• Tachypnea (RR > 30 breaths/min)

• Arterial hypotension (SBP < 90mmHg)

• Positive costovertebral angle tenderness

• Urine culture with colony growth

• Hyperthermia (≥ 37.8°C)"

Exclusion Criteria:

• Do not wish to participate in the project.

• Used antimicrobials prior to hospitalization (3-day period).

• those who are allergic to cefuroxime.

• Have a urine culture antibiogram resistant to cefuroxime AND absence of clinicalimprovement (in this case, will be excluded as modified intention to treat).

• Have a diagnosis other than pyelonephritis, for example, appendicitis.

• those in septic shock, defined as:

• the need for vasopressor to maintain a mean arterial pressure ≥ 65 mmHg andlactate > 2 mmol/l or 2 points on qSOFA. qSOFA will be considered positive whenat least two of the following clinical criteria are present:

• Respiratory rate greater than or equal to 22 breaths per minute;

• Altered level of consciousness (Glasgow Coma Scale score less than 15);

• Systolic blood pressure less than or equal to 100 mmHg.