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[Antibiotic treatment of acute pyelonephritis in the child]
1Service de pédiatrie et de pathologie infectieuse, hôpital Trousseau, Paris, France.
Insights
Effective antimicrobial therapy for pediatric pyelonephritis, often caused by ampicillin-resistant E. coli, requires careful antibiotic selection and administration. Current guidelines vary, but newer data suggest oral sequential treatment may shorten hospital stays.
Area of Science:
- Pediatric infectious diseases
- Nephrology
- Pharmacology
Context:
- Pyelonephritis in children necessitates prompt bacterial eradication to prevent renal scarring.
- Escherichia coli (E. coli) accounts for approximately 90% of outpatient acute pyelonephritis cases.
- A significant portion (40%) of E. coli strains exhibit ampicillin resistance.
Purpose:
- To review current antimicrobial therapy options for pediatric pyelonephritis.
- To highlight the divergence in therapeutic guidelines regarding administration route, monotherapy vs. bitherapy, treatment duration, and hospitalization.
- To identify key risk factors influencing treatment choices.
Summary:
- Effective antibiotics include 3rd-generation cephalosporins, amoxicillin-clavulanic acid, and aminoglycosides.
- Treatment decisions are guided by risk factors like young age, fever, vomiting, dehydration, uropathy, and poor compliance.
- Recent evidence supports oral sequential treatment for potentially shorter hospitalizations.
Impact:
- Informs clinical decision-making for pediatric pyelonephritis management.
- Addresses the need for standardized treatment protocols and further long-term comparative studies.
- Contributes to preventing chronic pyelonephritis in adulthood.
Abstract:
Antimicrobial therapy for pyelonephritis in children must quickly eradicate the bacterial infection and prevent scars in renal parenchyma. Escherichia coli (E Coli) is found in about 90% of cases of acute pyelonephritis in outpatients, 40% of E coli being ampicillin-resistant. The present effective antibiotics are: 3rd-generation cephalosporines, amoxicillin-clavulanic acid association, and aminoglycosides. In the literature therapeutical guides are divergent concerning the route of administration (oral or i.v.), mono or bitherapy, the duration of the treatment (usually for 10 days), and the need for hospitalisation. The criteria for choice are risk factors such as: very young age (< 6 months), fever with toxic symptoms, vomiting, dehydration, uropathy, and poor compliance. There are few long term studies which compare two, therapeutic regimens and no evaluation of the frequency of consequent chronic pyelonephritis in adult age has taken place. Recent data suggest that an oral sequential treatment may permit a shorter hospital stage. The trend is chiefly to do bona fide recommendations more than elaboration of a true consensus.