Which statement best differentiates management of acute pyelonephritis from cystitis in otherwise healthy outpatients?

• A. Topical antibiotics.
• B. Pyelonephritis may require longer therapy and systemic symptoms; start with oral antibiotics if mild, or IV therapy in moderate-severe cases; treat for 5–14 days.
• C. Pyelonephritis always requires hospitalization and IV vancomycin.
• D. Pyelonephritis is treated the same as cystitis.

Answer: (B)

The key idea is that acute pyelonephritis and cystitis are managed differently because pyelonephritis involves the kidneys and can cause systemic symptoms, so therapy is guided by severity and may require a different route and longer duration than cystitis.

In otherwise healthy outpatients, mild acute pyelonephritis can be started on oral antibiotics, but if symptoms are more significant or systemic signs appear, IV antibiotics are used, at least temporarily, with a longer overall course—typically 5 to 14 days. This reflects the need to ensure adequate kidney penetration and to address potential bacteremia, unlike cystitis, which is a lower urinary tract infection usually managed with a shorter, exclusively oral course and without IV therapy.

The other options don’t fit because topical antibiotics aren’t used for UTIs, pyelonephritis does not universally require hospitalization or IV vancomycin, and it is not treated the same as cystitis.