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Oral ceftibuten switch therapy for acute pyelonephritis in children
A Vilaichone1, D Watana, T Chaiwatanarat
1Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Insights
Oral ceftibuten switch therapy is a safe and effective treatment for acute pyelonephritis in children, reducing hospitalization duration. This approach offers a cost-effective alternative to intravenous antibiotics.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Pharmacology
Background:
- Acute pyelonephritis is a common pediatric kidney infection.
- Intravenous antibiotics are standard but require hospitalization.
- Switching to oral therapy after initial treatment can improve patient outcomes and reduce costs.
Purpose of the Study:
- To compare the efficacy of oral ceftibuten switch therapy versus continued intravenous ceftriaxone in children with acute pyelonephritis.
- To evaluate short-term and long-term outcomes, including renal scarring and recurrent infections.
- To assess the impact on hospitalization duration and healthcare expenditure.
Main Methods:
- A randomized controlled study involving 36 pediatric patients with confirmed acute pyelonephritis.
- Patients received initial intravenous ceftriaxone, then switched to oral ceftibuten (study group) or continued ceftriaxone (control group) after defervescence.
- Outcomes assessed included urine sterilization, renal scarring via 99mTc-dimercaptosuccinic acid (DMSA) scans, recurrent infections, and hospitalization duration.
Main Results:
- Both groups achieved urine sterilization by day 14.
- Renal scarring incidence was similar between the ceftibuten group (66.6%) and the ceftriaxone group (61.1%).
- No significant difference in recurrent infection rates was observed; however, hospitalization was shorter in the ceftibuten group.
Conclusions:
- Oral ceftibuten switch therapy is a safe and effective option for treating acute pyelonephritis in children.
- This strategy can lead to reduced hospitalization times and significant healthcare cost savings.
- Ceftibuten switch therapy is recommended for pediatric acute pyelonephritis management.
Abstract:
The available oral third generation of cephalosporin, "ceftibuten" was used to substitute the intravenous drug after defervescence in acute pyelonephritis in children. This randomized controlled study compared the efficacy of an oral ceftibuten switch therapy with a ceftriaxone in both short-term and long-term outcomes. 36 99mTc-dimercaptosuccinic acid (DMSA) scan proved pyelonephritis patients were randomized into the study group, "ceftibuten" (N=18) and the control group, "ceftriaxone" (N=18). Ceftriaxone (75 mg/kg/day) was the initial antibiotic in both groups. After defervescence for 24-48 hours, oral ceftibuten (9 mg/kg/day) was substituted in the study group and continued for 10 days. The subject characteristics and laboratory data were not different between the two groups. The urine culture at D14 was sterilized in both groups. The incidence of renal scarring was 66.6 per cent and 61.1 per cent in the study group and the control group respectively. The rate of recurrent infection showed no statistical significance. The duration of hospitalization was shorter in the study group than in the control. In conclusion, oral ceftibuten switch therapy can be recommended as a safe and effective treatment for acute pyelonephritis in children. The use of oral therapy may result in a significant reduction of health care expenditure.
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