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Treatment of children with acute pyelonephritis: a prospective randomized study
1Department of Pediatrics, AZ VUB, Brussels, Belgium.
Insights
A 7-day intravenous antibiotic course for acute pyelonephritis in children showed similar outcomes to a 3-day course. However, delayed treatment in the 3-day group increased the risk of renal sequelae.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Radiology
Background:
- Acute pyelonephritis is a serious kidney infection in children.
- Prompt and effective antibiotic treatment is crucial to prevent renal scarring and long-term complications.
Purpose of the Study:
- To compare the efficacy of 7-day versus 3-day intravenous antibiotic courses for acute pyelonephritis in children.
- To evaluate the impact of treatment duration and delay on renal sequelae.
Main Methods:
- Randomized controlled trial involving 92 children with acute pyelonephritis.
- Comparison of 7-day (Group A) and 3-day (Group B) intravenous antibiotic regimens, both followed by oral treatment.
- Renal scarring assessed by Technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy at admission and 6 months post-treatment.
Main Results:
- No statistically significant difference in persistent renal abnormalities between the 7-day and 3-day groups (24% vs. 44%).
- In the 3-day group, delayed treatment (over 1 week) was associated with a significantly higher percentage of patients with renal sequelae (P<0.01).
- Treatment delay did not significantly impact sequelae rates in the 7-day group.
Conclusions:
- A 3-day intravenous antibiotic course followed by oral treatment is comparable to a 7-day course for acute pyelonephritis in children regarding renal sequelae.
- Timely initiation of treatment is critical, especially for shorter antibiotic courses, to minimize the risk of long-term kidney damage.
Abstract:
The aim of this study was to compare, in children with acute pyelonephritis, the efficacy of 7 days' (group A) and 3 days' (group B) intravenous antibiotics, both followed by an oral treatment. Children were randomized after 3 days of intravenous treatment. Technetium-99m dimercaptosuccinic acid (DMSA) scintigraphy was performed within the first days after admission and repeated 6 months later. Total or partial persistence of renal abnormalities on the 6-month DMSA scintigraphy was used as the endpoint of the study. Among the 92 children included in the study, 87 were followed for at least 6 months (43 in group A and 44 in group B) and were eligible for analysis. Late DMSA was abnormal in 9 kidneys of group A and 12 kidneys of group B, representing respectively 24% and 44% of kidneys with abnormalities on the initial DMSA (difference statistically not significant). When the patients were stratified according to the delay of treatment, the percentage of patients with sequelae in group A was comparable, whether the delay was less or more than 1 week. In group B, the percentage of patients with sequelae was significantly higher (P<0.01) when the delay was more than 1 week.