Prospective, randomized trial comparing short and long intravenous antibiotic treatment of acute pyelonephritis in children: dimercaptosuccinic acid scintigraphic evaluation at 9 months.
OBJECTIVE
We report a prospective, randomized, multicenter trial that compared the effect of 3 vs 8 days of intravenous ceftriaxone treatment on the incidence of renal scarring at 6 to 9 months of follow-up in 383 children with a first episode of acute pyelonephritis.


METHODS
After initial treatment with intravenous netilmicin and ceftriaxone, patients were randomly assigned to either 5 days of oral antibiotics (short intravenous treatment) or 5 days of intravenous ceftriaxone (long intravenous treatment). Inclusion criteria were age 3 months to 16 years and first acute pyelonephritis episode, defined by fever of >38.5 degrees C, C-reactive protein level of >20 mg/L, and bacteriuria at >10(5)/mL. All patients underwent 99m technetium-dimercaptosuccinic acid scintigraphy 6 to 9 months after inclusion. A total of 548 children were included, 48 of whom were secondarily excluded and 117 of whom were lost to follow-up or had incomplete data; therefore, 383 children were eligible, 205 of them in the short intravenous treatment group and 178 in the long intravenous treatment group.


RESULTS
At inclusion, median age was 15 months, median duration of fever was 43 hours, and median C-reactive protein level was 122 mg/L. A total of 37% (143 of 383) of patients had a vesicoureteral reflux grades 1 to 3. Patient characteristics at inclusion were similar in both groups, except for a significantly higher proportion of girls in the short intravenous treatment group. The frequency of renal scars at scintigraphy was similar in both groups. Multivariate analysis demonstrated that renal scars were significantly associated with increased renal height at initial ultrasound and with the presence of grade 3 vesicoureteric reflux.


CONCLUSIONS
The incidence of renal scars was similar in patients who received 3 days compared 8 days of intravenous ceftriaxone. Increased renal height at initial ultrasound examination and grade 3 vesicoureteric reflux were significant risk factors for renal scars.
Bouissou
François
F
Néphrologie Pédiatrique, Hôpital des Enfants, Université Paul Sabathier, Centre Hospitalier Universitaire Purpan, Toulouse, France. bouissou.f@chu-toulouse.fr
Munzer
Caroline
C
Decramer
Stéphane
S
Roussel
Bernard
B
Novo
Robert
R
Morin
Denis
D
Lavocat
Marie Pierre
MP
Guyot
Claude
C
Taque
Sophie
S
Fischbach
Michel
M
Ouhayoun
Eric
E
Loirat
Chantal
C
D000208:Acute Disease; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002443:Ceftriaxone / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007677:Kidney Function Tests; D016015:Logistic Models; D008297:Male; D009428:Netilmicin / Q000008:administration & dosage*; D016017:Odds Ratio; D011446:Prospective Studies; D011704:Pyelonephritis / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D011877:Radionuclide Imaging; D018570:Risk Assessment; D012720:Severity of Illness Index; D004113:Succimer; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D009428:Netilmicin; D002443:Ceftriaxone; D004113:Succimer