Comparative Effectiveness of Antibiotic Treatment Duration in Children With Pyelonephritis
Miriam T Fox1, Joe Amoah1, Alice J Hsu2
1Department of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
Short-course antibiotic therapy for childhood pyelonephritis appears as effective as longer durations, potentially reducing the risk of drug-resistant infections. Further research is needed to confirm these findings in pediatric patients.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Clinical outcomes research
Background:
- Current national guidelines recommend 7–14 days of antibiotic treatment for pediatric pyelonephritis.
- Evidence supporting precise treatment duration is limited, necessitating further investigation.
- Optimizing antibiotic duration is crucial for efficacy and minimizing antimicrobial resistance.
Purpose of the Study:
- To compare clinical outcomes between short-course (6–9 days) and prolonged-course (≥10 days) antibiotic therapy for pediatric pyelonephritis.
- To evaluate the association between antibiotic treatment duration and treatment failure.
- To assess the risk of subsequent drug-resistant urinary tract infections (UTIs).
Main Methods:
- Retrospective observational study involving 791 children diagnosed with pyelonephritis.
- Utilized inverse probability of treatment weighted propensity score analysis.
- Compared composite outcomes of treatment failure and secondary drug-resistant UTIs within 30 days post-therapy.
Main Results:
- Treatment failure rates were similar between short-course (11.2%) and prolonged-course (9.4%) antibiotic groups (OR, 1.22; 95% CI, 0.75–1.98).
- No significant difference was observed in the odds of developing a drug-resistant uropathogen in subsequent UTIs between the groups.
- Median treatment durations were 8 days for short-course and 11 days for prolonged-course therapy.
Conclusions:
- Short-course antibiotic therapy may be a viable and effective alternative for treating pediatric pyelonephritis.
- Shorter treatment durations could potentially reduce the incidence of future drug-resistant UTIs.
- Further research is warranted to validate these findings and inform clinical practice guidelines.
Importance:
National guidelines recommend treating children with pyelonephritis for 7 to 14 days of antibiotic therapy, yet data are lacking to suggest a more precise treatment duration.
Objective:
To compare the clinical outcomes of children receiving a short-course vs a prolonged-course of antibiotic treatment for pyelonephritis.
Design, Setting, And Participants:
Retrospective observational study using inverse probability of treatment weighted propensity score analysis of data from 5 hospitals in Maryland between July 1, 2016, and October 1, 2018. Participants were children aged 6 months to 18 years with a urine culture growing Escherichia coli, Klebsiella species, or Proteus mirabilis with laboratory and clinical criteria for pyelonephritis.
Exposures:
Treatment of pyelonephritis with a short-course (6 to 9 days) vs a prolonged-course (10 or more days) of antibiotics.
Main Outcomes And Measures:
Composite outcome of treatment failure within 30 days of completing antibiotic therapy: (a) unanticipated emergency department or outpatient visits related to urinary tract infection symptoms, (b) hospital readmission related to UTI symptoms, (c) prolongation of the planned, initial antibiotic treatment course, or (d) death. A subsequent urinary tract infection caused by a drug-resistant bacteria within 30 days was a secondary outcome.
Results:
Of 791 children who met study eligibility criteria (mean [SD] age 9.2 [6.3] years; 672 [85.0%]) were girls, 297 patients (37.5%) were prescribed a short-course and 494 patients (62.5%) were prescribed a prolonged-course of antibiotics. The median duration of short-course therapy was 8 days (interquartile range, 7-8 days), and the median duration of prolonged-course therapy was 11 days (interquartile range, 11-12 days). Baseline characteristics were similar between the groups in the inverse probability of treatment weighted cohort. There were 79 children (10.1%) who experienced treatment failure. The odds of treatment failure were similar for patients prescribed a short-course vs a prolonged-course of antibiotics (11.2% vs 9.4%; odds ratio, 1.22; 95% CI, 0.75-1.98). There was no significant difference in the odds of a drug-resistant uropathogen for patients with a subsequent urinary tract infection within 30 days when prescribed a short-courses vs prolonged-course of antibiotics (40% vs 64%; odds ratio, 0.36; 95% CI, 0.09-1.43).
Conclusions And Relevance:
The study findings suggest that short-course antibiotic therapy may be as effective as prolonged-courses for children with pyelonephritis, and may mitigate the risk of future drug-resistant urinary tract infections. Additional studies are needed to confirm these findings.
More Related Videos
Related Concept Videos
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Pharmacokinetics in Pediatric Patients: Drug Excretion
01:27Acute Pyelonephritis I: Introduction
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:26Tonsillitis II: Management