title: Evaluation of the efficacy and tolerance of a short 7 day third-generation cephalosporin treatment in the management of acute pyelonephritis in young women in the emergency department.
abstract: Urinary tract infections, among the leading causes of antibiotic prescriptions in adult women, are complicated by increasing antibiotic resistance. Current recommendations propose a 7 day treatment with fluoroquinolones or a 10-14 day course of third-generation cephalosporins (3GC). Our aim was to study the efficiency and tolerance of a short 7 day treatment with 3GC in uncomplicated acute pyelonephritis in women aged between 18 and 65 years.
  
  
  
  This study was an open, prospective, non-comparative, monocentric pilot study with consecutive patients. We included women between 18 and 65 years old who had been admitted to the emergency department with a diagnosis of acute pyelonephritis. The treatment consisted of 1 g of ceftriaxone injection followed by 6 days of 400 mg of cefixime per day. The primary endpoint was negative urine cultures on day 9. We opted for Fleming's multistage design for this trial. ClinicalTrials.gov number: NCT01390623.
  
  
  
  Thirty-seven patients were analysed. The bacteriological response consisted of negative urine cultures for all 37 patients on day 9. On day 9, 30 patients were completely asymptomatic, while 7 exhibited clinical improvement though persistence of bladder irritation or flank pain. On day 37, there were no remaining symptoms and no recurrences of urinary tract infection, as noted during the last follow-up visits.
  
  
  
  These results suggest that acute pyelonephritis in women could be successfully treated with a short-term course of 1 g of ceftriaxone on the first day followed by 400 mg of cefixime per day for 6 days. These positive results must be confirmed by a non-inferiority study.
authors.affiliation: Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France fmoustafa@chu-clermontferrand.fr.
authors.forename: F
authors.initials: F
authors.lastname: Moustafa
authors.affiliation: Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: G
authors.initials: G
authors.lastname: Nguyen
authors.affiliation: Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: T
authors.initials: T
authors.lastname: Mathevon
authors.affiliation: Service de maladies infectieuses, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: O
authors.initials: O
authors.lastname: Baud
authors.affiliation: Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France Université d'Auvergne, Clermont-I, UFR de Médecine, Clermont-Ferrand, France.
authors.forename: J
authors.initials: J
authors.lastname: Saint-Denis
authors.affiliation: Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: N
authors.initials: N
authors.lastname: Dublanchet
authors.affiliation: Service de Biostatistiques, CHU Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: B
authors.initials: B
authors.lastname: Pereira
authors.affiliation: Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Shinjo
authors.affiliation: Laboratoire de bactériologie, mycologie et parasitologie, CHU Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: J P
authors.initials: JP
authors.lastname: Romaszko
authors.affiliation: Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France.
authors.forename: L
authors.initials: L
authors.lastname: Dopeux
authors.affiliation: Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France School of Exercise Science, Australian Catholic University, Melbourne, VIC, Australia Laboratory of Metabolic Adaptations to Exercise in Physiological and Pathological Conditions (AME2P, EA 3533), Blaise Pascal University, Clermont-Ferrand, France.
authors.forename: F
authors.initials: F
authors.lastname: Dutheil
authors.affiliation: Service des urgences, Pôle SAMU-SMUR-Urgences, CHU Gabriel Montpied, Clermont-Ferrand, France Université d'Auvergne, Clermont-I, UFR de Médecine, Clermont-Ferrand, France.
authors.forename: J
authors.initials: J
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000009:adverse effects*; D002511:Cephalosporins / Q000008:administration & dosage* / Q000009:adverse effects*; D064420:Drug-Related Side Effects and Adverse Reactions; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011704:Pyelonephritis / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins