One or three weeks' treatment of acute pyelonephritis? A double-blind comparison, using a fixed combination of pivampicillin plus pivmecillinam.
The clinical and bacteriological effects of 1 and 3 weeks' pivampicillin plus pivmecillinam treatment were compared in a double-blind, randomized study of patients with acute pyelonephritis. Three weeks after the end of active treatment, clinical success was seen in 29 (91%) of the 32 patients on 1-week treatment, compared with 28 (97%) of the 29 patients treated for 3 weeks. Bacteriological success was seen in only nine (28%) patients in the 1-week group vs. 20 (69%) in the 3-week group (p = 0.004). This difference was mainly due to a large number of relapses of lower urinary tract infection in the 1-week group. Even in uncomplicated cases, the bacteriological result of the 1-week treatment was unsatisfactory. Side-effects were more common in the 3-week treatment group. In conclusion, 1-week treatment of patients with acute pyelonephritis is too short. Three weeks' treatment is effective in uncomplicated cases, but even longer treatment or low-dose prophylaxis is indicated in certain patients with predisposing factors.
Jernelius
H
H
Department of Infectious Diseases, County Hospital, Skövde, Sweden.
Zbornik
J
J
Bauer
C A
CA
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000560:Amdinocillin / Q000008:administration & dosage*; D000561:Amdinocillin Pivoxil / Q000008:administration & dosage*; D000667:Ampicillin / Q000031:analogs & derivatives*; D002986:Clinical Trials as Topic; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010917:Pivampicillin / Q000008:administration & dosage*; D011379:Prognosis; D011704:Pyelonephritis / Q000188:drug therapy* / Q000382:microbiology; D012008:Recurrence; D013997:Time Factors
D004338:Drug Combinations; D010917:Pivampicillin; D000561:Amdinocillin Pivoxil; D000667:Ampicillin; D000560:Amdinocillin