Randomised controlled trial of three day versus 10 day intravenous antibiotics in acute pyelonephritis: effect on renal scarring

Autor: Daniel O. Slosman, Bernadette Mermillod, I Engel-Bicik, Eric Girardin, Daivy Benador, Thomas J. Neuhaus, David Nadal, J P Papazyan, U V Willi
Rok vydání: 2001
Předmět:
Male
medicine.medical_specialty
Adolescent
medicine.medical_treatment
Urine
urologic and male genital diseases
Scintigraphy
Drug Administration Schedule
Statistics
Nonparametric
law.invention
Cicatrix
Randomized controlled trial
law
medicine
Humans
Child
Radionuclide Imaging
Pyelonephritis/complications/drug therapy/radionuclide imaging
Kidney
Chemotherapy
ddc:618
medicine.diagnostic_test
Pyelonephritis
business.industry
Ceftriaxone
Infant
Cephalosporins/administration & dosage
medicine.disease
Kidney Diseases/etiology/radionuclide imaging
Surgery
Cephalosporins
medicine.anatomical_structure
Treatment Outcome
Ceftriaxone/administration & dosage
Child
Preschool
Pediatrics
Perinatology and Child Health
Acute Disease
General and Specialist Paediatrics
Regression Analysis
Female
Kidney Diseases
business
Cefixime
Cicatrix/etiology/radionuclide imaging
medicine.drug
Kidney disease
Zdroj: Archives of Disease in Childhood, Vol. 84, No 3 (2001) pp. 241-6
ISSN: 1468-2044
0003-9888
Popis: BACKGROUND Acute pyelonephritis often leaves children with permanent renal scarring. AIMS To compare the prevalence of scarring following initial treatment with antibiotics administered intravenously for 10 or three days. METHODS In a prospective two centre trial, 220 patients aged 3 months to 16 years with positive urine culture and acute renal lesions on initial DMSA scintigraphy, were randomly assigned to receive intravenous ceftriaxone (50 mg/kg once daily) for 10 or three days, followed by oral cefixime (4 mg/kg twice daily) to complete a 15 day course. After three months, scintigraphy was repeated in order to diagnose renal scars. RESULTS Renal scarring developed in 33% of the 110 children in the 10 day intravenous group and 36% of the 110 children in the three day group. Children older than 1 year had more renal scarring than infants (42% (54/129) and 24% (22/91), respectively). After adjustment for age, sex, duration of fever before treatment, degree of inflammation, presence of vesicoureteric reflux, and the patients9 recruitment centres, there was no significant difference between the two treatments on renal scarring. During follow up, 15 children had recurrence of urinary infection with no significant difference between the two treatment groups. CONCLUSION In children with acute pyelonephritis, initial intravenous treatment for 10 days, compared with three days, does not significantly reduce the development of renal scarring.
Databáze: OpenAIRE
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