Oral antibiotics may be as effective as the combination of injection and oral antibiotics for kidney infections in children

Hodson EM, Willis NS, Craig JC

Published Online:

March 17, 2010

Acute pyelonephritis refers to infection of the kidneys and is the most severe form of urinary tract infection (UTI). It causes high fever, vomiting, stomach pain, irritability and poor feeding in infants. Usual treatment is antibiotics given first by injection (IV) and then orally for 7 to 14 days to clear the infection and prevent kidney damage. This review identified 23 studies (3407 children). These results suggest that children with acute pyelonephritis can be treated effectively with cefixime, ceftibuten or amoxicillin/clavulanic acid given orally or with short courses (2 to 4 days) of IV therapy followed by oral therapy. If IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective.

Abstract (click to read)

Background:

Urinary tract infection (UTI) is one of the most common bacterial infection in infants. The most severe form of UTI is acute pyelonephritis, which results in significant acute morbidity and may cause permanent kidney damage. Published guidelines recommend treatment of acute pyelonephritis initially with intravenous (IV) therapy followed by oral therapy for seven to 14 days though there is no consensus on the duration of either IV or oral therapy.

Objectives:

To determine the benefits and harms of different antibiotic regimens for the treatment of acute pyelonephritis in children.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, reference lists of articles and conference proceedings without language restriction.
Date of most recent search: December 2006.

Selection criteria:

Randomised and quasi-randomised controlled trials comparing different antibiotic agents, routes, frequencies or durations of therapy in children aged 0 to 18 years with proven UTI and acute pyelonephritis were selected.

Data collection and analysis:

Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI).

Main results:

Twenty three studies (3407 children) were eligible for inclusion. No significant differences were found in persistent kidney damage at six to 12 months (824 children: RR 0.80, 95% CI 0.50 to 1.26) or in duration of fever (808 children: MD 2.05, 95% CI -0.84 to 4.94) between oral antibiotic therapy (10 to 14 days) and IV therapy (3 days) followed by oral therapy (10 days). Similarly no significant differences in persistent kidney damage (3 studies, 341 children: RR 1.13, 95% CI 0.86 to 1.49) were found between IV therapy (3 to 4 days) followed by oral therapy and IV therapy for 7 to 14 days. No significant differences in efficacy were found between daily and thrice daily administration of aminoglycosides (179 children, persistent symptoms at 3 days: RR 1.98, 95% CI 0.37 to 10.53).

Authors' conclusions:

These results suggest that children with acute pyelonephritis can be treated effectively with oral antibiotics (cefixime, ceftibuten and amoxicillin/clavulanic acid) or with short courses (2 to 4 days) of IV therapy followed by oral therapy. If IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective. Studies are required to determine the optimal total duration of therapy.

This record should be cited as:

Hodson EM, Willis NS, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003772. DOI: 10.1002/14651858.CD003772.pub3

Assessed as up to date:

October 5, 2007

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Primary Review Group:

Renal Group

Health topics:

Infectious disease > Urinary tract infections > Treatment: pyelonephritis

Kidney disease > Urinary tract infections > Treatment: pyelonephritis

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Oral antibiotics may be as effective as the combination of injection and oral antibiotics for kidney infections in children

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