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Short vs long-course antibiotic therapy in pyelonephritis: a comparison of systematic reviews and guidelines for the
Luca Erba1, Ludovico Furlan2, Alice Monti2
1Università Degli Studi Di Milano, Milan, Italy. luca.erba@unimi.it.
Background:
The Italian Society of Internal Medicine (SIMI) Choosing Wisely Campaign has recently proposed, among its five items, to reduce the prescription of long-term intravenous antibiotics if not indicated. The aim of our study was to assess the available evidences on optimal duration of antibiotic treatment in pyelonephritis through a systematic review of secondary studies.
Materials And Methods:
We searched for all guidelines on pyelonephritis and systematic reviews assessing the optimal duration of antibiotic therapy in this type of infection. We compared the recommendations of the three most cited and recent guidelines on the topic of interest. We extracted data of non-duplicated RCT from the selected systematic reviews and performed meta-analyses for clinical and microbiological failure. A trial sequential analysis (TSA) was also achieved to identify the need for further evidence.
Results:
We identified 4 systematic reviews, including data from 10 non-duplicated RCTs (1536 patients). The meta-analysis showed a higher rate of clinical cure for short-course antibiotic treatment (RR for clinical failure 0.70, 95% CI [0.53-0.94]). No significant difference in the rate of microbiological failure (RR 1.06, 95% CI [0.75-1.49]) was observed. In terms of clinical cure, the TSA suggests that current evidence is sufficient to consider short course at least as effective as long-course treatment. Selected guidelines recommend considering shorter courses, but do not cite most of the published RCTs.
Conclusions:
Short-course antibiotic treatment is at least as effective as longer courses for both microbiological and clinical success in the treatment of acute uncomplicated pyelonephritis.
Insights
Short-course antibiotic treatment effectively treats pyelonephritis, matching longer durations for clinical and microbiological success. Evidence supports shorter antibiotic courses for better patient outcomes.
Area of Science:
- Infectious Diseases
- Internal Medicine
- Clinical Pharmacology
Background:
- The Italian Society of Internal Medicine (SIMI) Choosing Wisely Campaign recommends reducing long-term intravenous antibiotic prescriptions when not indicated.
- Pyelonephritis treatment guidelines often lack comprehensive evidence on optimal antibiotic duration.
Purpose of the Study:
- To systematically review existing evidence on the optimal duration of antibiotic treatment for pyelonephritis.
- To compare recommendations from leading clinical guidelines with available research data.
Main Methods:
- Systematic review of guidelines and meta-analysis of randomized controlled trials (RCTs) on pyelonephritis antibiotic duration.
- Data extraction from 4 systematic reviews encompassing 10 non-duplicated RCTs (1536 patients).
- Trial sequential analysis (TSA) to assess the sufficiency of current evidence.
Main Results:
- Meta-analysis indicated a higher clinical cure rate with short-course antibiotic treatment (RR for clinical failure 0.70, 95% CI [0.53-0.94]).
- No significant difference in microbiological failure rates between short-course and long-course treatments was observed (RR 1.06, 95% CI [0.75-1.49]).
- TSA suggests current evidence is adequate to support short-course treatment as effective as longer courses for clinical cure.
Conclusions:
- Short-course antibiotic therapy is as effective as longer courses for achieving both clinical and microbiological success in acute uncomplicated pyelonephritis.
- Current evidence supports shorter antibiotic durations, though some guidelines may not fully reflect the latest RCT data.
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