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Published on: July 18, 2017
Children with acute pyelonephritis need medical re-evaluation when home-treated with oral antibiotics
Line Thousig Sehested1, Konstantinos Kamperis2,3, Louise Winding4
1Department of Paediatrics and Adolescence Medicine, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark.
Insights
Home treatment for childhood pyelonephritis with oral antibiotics is safe. However, 20% of children require treatment changes, particularly younger children on piv-mecillinam, necessitating close clinical monitoring.
Area of Science:
- Pediatric infectious diseases
- Pharmacology
- Clinical microbiology
Background:
- Acute pyelonephritis is a serious kidney infection in children.
- Home-treatment with oral antibiotics can be a viable alternative to hospitalization.
- Piv-mecillinam and amoxicillin-clavulanate are commonly used oral antibiotics for this condition.
Purpose of the Study:
- To compare the efficacy and safety of home-treatment with oral piv-mecillinam versus amoxicillin-clavulanate in children with acute pyelonephritis.
- To identify factors influencing treatment success or failure.
Main Methods:
- A prospective study involving children over 6 months old with culture-confirmed pyelonephritis.
- Home-treatment with either piv-mecillinam or amoxicillin-clavulanate.
- Follow-up via phone on day two and clinical review on day three.
Main Results:
- 80% of 418 children responded well to initial oral antibiotic treatment.
- 20% required a change in treatment due to insufficient improvement or resistance.
- Piv-mecillinam showed lower efficacy in children under 5 years old, possibly due to tablet formulation issues.
Conclusions:
- Home-treatment for pediatric pyelonephritis is safe when closely monitored.
- Clinical re-evaluation during treatment is crucial, as 20% may need alternative therapies.
- Amoxicillin-clavulanate may be more effective than piv-mecillinam in younger children.
Aim:
To investigate the efficacy and safety of home-treatment with oral piv-mecillinam or amoxicillin-clavulanate in children with acute pyelonephritis.
Methods:
Children aged over 6 months diagnosed with culture confirmed pyelonephritis at Danish Paediatric Departments were home-treated with piv-mecillinam (tablets) or amoxicillin-clavulanate (liquid or tablets). Follow-up was performed by phone (second treatment day) and clinical review of the patients in the hospital (day three).
Results:
Four hundred eighteen children were included. In total, 333/418 (80%) responded well to the initial oral antibiotic treatment. 85/418 (20%) were changed to another treatment of these 47/418 (11%) to a second-line oral antibiotic and 38/418 (9%) to intravenous antibiotics due to insufficient clinical improvement or bacterial resistance. Bacterial resistance was similar for piv-mecillinam and amoxicillin-clavulanate: 4/74 (5%) versus 33/333 (10%) (p = 0.22). Insufficient clinical improvement, despite no resistance, primarily occurred in children treated with piv-mecillinam: 16/74 (22%) versus 28/344 (8%) (p < 0.001), and predominantly occurred in piv-mecillinam treated children <5 years: 7/20 (35%) versus 9/54 (17%) (p < 0.05), potentially because of problems with piv-mecillinam tablets. In the study population no cases of death or septicemia developed after start of initial oral treatment.
Conclusion:
A home-treatment regime for pyelonephritis in children >6 months is safe; however, during treatment, clinical re-evaluation is required as in 20% of cases a change in treatment was necessary.
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