[Urinary tract infection and antibiotics: oral or intravenous route?]

Management of acute pyelonephritis has long been discussed. The French drug agency (Agence Française de Sécurité Sanitaire des Produits de Santé [AFSSAPS]) has published guidelines for clinical practice in 2007: two to four days of initial parenteral antibiotic therapy followed by oral antibiotics, for a total duration of 10 to 14 days. However, recent data are conflictable and oral antibiotic therapy may be sufficient in some cases. Clinical trials on oral therapy of acute pyelonephritis in selected groups of children are currently ongoing. We suggest following AFSSAPS recommendations in clinical practice until the results of such trials become available. In the future, we can speculate that antibiotic therapy may be reduced in some low risk patients, keeping in mind that around 15% of children with acute pyelonephritis will develop renal scars which may lead to hypertension and microalbuminuria in adulthood.