[Management of acute pyelonephritis in patients older than 3 months: survey conducted in 39 paediatric emergency departments of the Ile de France Region in 2004].
OBJECTIVE
To describe the different modalities of ambulatory management of acute pyelonephritis in patients older than 3 months of age in paediatric emergency units of the Ile de France region in 2004.


METHODS
Between October 2003 and April 2004, referents of 39 paediatric emergency units of the Ile de France region were questioned through a written questionnaire concerning the management of acute pyelonephritis: in or outpatient modalities, antibiotic regimen (molecule and route of administration), investigations and follow-up.


RESULTS
Thirty-one questionnaires (79.5%) were returned and analysed. A written protocol was available in 60% of the units. Outpatient management was performed in 24/31 centres. Young age, poor clinical tolerance, urological abnormalities and social difficulties were the major contra-indications for such management. Ultrasonic echography at diagnosis (within 24 h) was performed in 50% of the units. Antibiotics were started using IV route in 18/24 units (75%) and ceftriaxone and aminoside were respectively prescribed in 100% and 29.4% of the units for a duration of 1 to 5 days before switching to the oral route. Antibiotherapy was started orally in 6 units and cefixime was chosen by 5 of them. Follow-up consultations were scheduled in 100% of the units but with various delay after initiation of the treatment. The total duration of treatment was mostly 10 days and oral prophylactic antibiotherapy was prescribed by 10/24 centres after completion of the treatment. Cystoureterography was systematically realized by 83.3% of the units.


CONCLUSIONS
Despite important differences in the management of acute pyelonephritis in Ile-de-France, a majority of the units follows similar therapeutic modalities. In the absence of consensus, new recommendations are necessary concerning the management of pyelonephritis in infants and children in France.
de La Vaissière
B
B
Consultation, Urgences Pédiatriques, Pathologie Infectieuse et Tropicale, Hôpital d'Enfants Armand-Trousseau, Assistance publique-Hôpitaux de Paris, 26, avenue Arnold-Netter, 75012 Paris, France.
Castello
B
B
Quinet
B
B
Cohen
R
R
Grimprel
E
E
D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002433:Cefaclor / Q000008:administration & dosage / Q000627:therapeutic use; D020682:Cefixime / Q000008:administration & dosage / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007223:Infant; D007263:Infusions, Parenteral; D007275:Injections, Intravenous; D015278:Intensive Care Units, Pediatric; D010045:Outpatients; D011704:Pyelonephritis / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000628:therapy*; D011795:Surveys and Questionnaires; D013997:Time Factors; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014567:Urography
D000900:Anti-Bacterial Agents; D002433:Cefaclor; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D020682:Cefixime