title: Early switch to oral versus intravenous antimicrobial treatment for hospitalized patients with acute pyelonephritis: a systematic review of randomized controlled trials.
abstract: BACKGROUND
  Acute pyelonephritis is a common infection with significant morbidity and mortality, particularly in pediatric populations. Early-switch strategies (from intravenous to oral treatment) may be an acceptable or even preferred option in the treatment of patients with acute pyelonephritis in terms of effectiveness and safety and can also reduce the economical burden associated with pyelonephritis.
  
  
  OBJECTIVE
  We sought to evaluate the effectiveness and safety of early-switch strategies in hospitalized patients with acute uncomplicated pyelonephritis.
  
  
  METHODS
  We searched in PubMed, Cochrane Central Register of Controlled Trials, and Scopus to identify randomized controlled trials (RCTs) that compared intravenous antibiotic regimens to regimens including an early switch to oral (after initial intravenous) treatment.
  
  
  RESULTS
  Eight RCTs (6 in children) were eligible for inclusion. In 5 RCTs the intravenous antibiotic treatment arms were not switched to oral treatment until the end of the study while in the remaining 3 RCTs the intravenous arms were switched late to oral treatment (after 5-10 days). Data regarding the incidence of renal scars, microbiological eradication, clinical cure, reinfection, persistence of acute pyelonephritis, and adverse events were provided in 4 (all pediatric trials), 6 (4 pediatric), 4 (2 pediatric), 5 (3 pediatric), 3 (1 pediatric), and 5 RCTs (3 pediatric), respectively. There were no differences regarding the above outcomes between the two compared treatment regimens in either pediatric or adult populations.
  
  
  CONCLUSIONS
  Early switch to oral antibiotic strategies seem to be as effective and safe as intravenous regimens for the treatment of hospitalized patients with acute pyelonephritis. These findings suggest that there is probably a potential to decrease the duration of intravenous treatment by 4-11 days in hospitalized patients with acute pyelonephritis without compromising their outcomes.
authors.affiliation: Alfa Institute of Biomedical Sciences, Athens, Greece.
authors.forename: Evridiki K
authors.initials: EK
authors.lastname: Vouloumanou
authors.forename: Petros I
authors.initials: PI
authors.lastname: Rafailidis
authors.forename: Maria S
authors.initials: MS
authors.lastname: Kazantzi
authors.forename: Stavros
authors.initials: S
authors.lastname: Athanasiou
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Falagas
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D015201:Meta-Analysis as Topic; D039781:PubMed; D011704:Pyelonephritis / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents