title: Antibiotics for acute pyelonephritis in children.
abstract: BACKGROUND
  Urinary tract infection (UTI) is one of the most common bacterial infection in infants. The most severe form of UTI is acute pyelonephritis, which results in significant acute morbidity and may cause permanent renal damage. Published guidelines recommend treatment of acute pyelonephritis initially with intravenous (IV) therapy followed by oral therapy for seven to 14 days though there is no consensus on the duration of either IV or oral therapy.
  
  
  OBJECTIVE
  To determine the benefits and harms of different antibiotic regimens for the treatment of acute pyelonephritis in children.
  
  
  METHODS
  We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, reference lists of articles and conference proceedings without language restriction. Date of most recent search: December 2006.
  
  
  METHODS
  Randomised and quasi-randomised controlled trials comparing different antibiotic agents, routes, frequencies or durations of therapy in children aged 0 to 18 years with proven UTI and acute pyelonephritis were selected.
  
  
  METHODS
  Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or mean difference (WMD) for continuous data with 95% confidence intervals (CI).
  
  
  RESULTS
  Twenty three studies (3295 children) were eligible for inclusion. No significant differences were found in persistent renal damage at 6 months (2 studies, 424 children: RR 0.87, 95% CI 0.35 to 2.16) or in duration of fever (2 studies, 693 children: WMD 1.54, 95% CI -1.67 to 4.76) between oral antibiotic therapy (10 to 14 days) and IV therapy (3 days) followed by oral therapy (10 days). Similarly no significant differences in persistent renal damage (3 studies, 341 children: RR 1.13, 95% CI 0.86 to 1.49) were found between IV therapy (3 to 4 days) followed by oral therapy and IV therapy for 7 to 14 days. No significant differences in efficacy were found between daily and thrice daily administration of aminoglycosides (1 study, 179 children, persistent symptoms at 3 days: RR 1.98, 95% CI 0.37 to 10.53).
  
  
  CONCLUSIONS
  These results suggest that children with acute pyelonephritis can be treated effectively with oral antibiotics (cefixime, ceftibuten and amoxycillin/clavulanic acid) or with short courses (2 to 4 days) of IV therapy followed by oral therapy. If IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective. Studies are required to determine the optimal total duration of therapy.
authors.affiliation: Children's Hospital at Westmead, Centre for Kidney Research, Locked Bag 4001, Westmead, NSW, Australia, 2145. Elisah@chw.edu.au
authors.forename: E M
authors.initials: EM
authors.lastname: Hodson
authors.forename: N S
authors.initials: NS
authors.lastname: Willis
authors.forename: J C
authors.initials: JC
authors.lastname: Craig
mesh_terms: D000208:Acute Disease; D000284:Administration, Oral; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D006801:Humans; D007223:Infant; D007275:Injections, Intravenous; D011704:Pyelonephritis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000900:Anti-Bacterial Agents