Therapy of symptomatic pyelonephritis in women

A prospective randomized controlled study was performed on 44 women with community-acquired, uncomplicated pyelonephritis requiring hospitalization. The study was designed to determine if an extended course of therapy (21 days) would be more effective than the conventional 10-day course of therapy. All patients initially received either gentamicin or tobramycin parenterally for 48 to 72 hours, and then were prescribed an oral agent that possessed in vitro inhibitory activity for the urinary pathogen to complete the course of therapy. Duration of medication was assigned according to a table of random digits. Of the 22 women receiving the 10-day treatment 17 were cured, 4 experienced a reinfection and none had a relapse, compared to 12, 5 and 3, respectively, of 22 receiving the 21-day treatment. Analysis of the therapeutic failures did not demonstrate any superior response for either treatment program (p less than 0.75 and greater than 0.50). No statistically increased incidence of adverse drug reactions occurred in patients receiving the extended course of therapy. Our data do not support an extended course of therapy in women with acute symptomatic pyelonephritis uncomplicated by structural abnormalities.