Randomized trial of oral versus sequential IV/oral antibiotic for acute pyelonephritis in children

Area of Science:

• Pediatric Nephrology
• Infectious Diseases
• Clinical Trials

Background:

• Acute pyelonephritis is a common kidney infection in children.
• Renal scarring is a potential complication that can lead to long-term kidney damage.
• Current treatment guidelines often involve intravenous antibiotics followed by oral therapy.

Purpose of the Study:

• To compare the efficacy of oral antibiotic treatment versus sequential intravenous/oral antibiotic treatment in preventing renal scarring.
• To evaluate the noninferiority of oral cefixime compared to intravenous ceftriaxone followed by oral cefixime in children with acute pyelonephritis.

Main Methods:

• A prospective multicenter trial randomized 171 children (1-36 months) with first-time acute pyelonephritis.
• Two groups received either 10 days of oral cefixime or 4 days of intravenous ceftriaxone followed by 6 days of oral cefixime.
• Dimercaptosuccinic acid (DMSA) scintigraphy was used to assess acute renal lesions and subsequent renal scarring at 6-8 months.

Main Results:

• No significant differences in clinical characteristics were observed between the treatment groups.
• The incidence of renal scarring was 30.8% in the oral treatment group and 27.3% in the sequential treatment group.
• The study included 171 infants and children, with 96 assessed for renal scarring in the per-protocol analysis.

Conclusions:

• While not statistically demonstrating noninferiority, the results align with previous studies.
• Oral antibiotic treatment appears to be a viable option for primary acute pyelonephritis in infants and young children.
• Supports the use of oral antibiotic monotherapy for initial episodes of acute pyelonephritis.