title: Is 5 days of oral fluoroquinolone enough for acute uncomplicated pyelonephritis? The DTP randomized trial.
abstract: The treatment duration of acute uncomplicated pyelonephritis (AUP) is still under debate. As shortening treatment duration could be a means to reduce antimicrobial resistance, we aimed to establish whether 5 days of antibiotic treatment is non-inferior to 10 days in patients with AUP. We performed an open-label prospective randomized trial comparing 5 days to 10 days of fluoroquinolone treatment for AUP. The inclusion criteria were: female patients aged ≥18 years with clinical signs of urinary tract infection, fever >38 °C, and positive urinalysis. Patients were randomized to either 5 or 10 days of fluoroquinolone treatment. Outcome was cure at day 10 and day 30 after the end of treatment. One hundred patients were randomized and 12 were excluded after randomization. The mean ± standard deviation (SD) age was 31.8 ± 11 years old and the mean ± SD temperature was 38.6 ± 0.7 °C. The main bacterium involved was Escherichia coli (n = 86; 97.7%) and 3 (3.4%) patients had a positive blood culture. In the post-hoc analysis, clinical cure 10 days after the end of the treatment was 28/30 (93.3%) in the 5-day arm and 36/38 (94.7%) in the 10-day arm (p = 1.00). At day 30, the clinical cure rate was 23/23 (100%) in the 5-day arm and 20/20 (100%) in the 10-day arm (p = 1.00). The microbiological cure rate was 20/23 (87.0%) in the 5-day arm and 16/20 (80.0%) in the 10-day arm (p = 1.00). The efficacy of 5 days of fluoroquinolone treatment does not seem different from 10 days of treatment for AUP.
authors.affiliation: Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France. aurelien.dinh@aphp.fr.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-5843-4819
authors.initials: A
authors.lastname: Dinh
authors.affiliation: Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France.
authors.forename: B
authors.initials: B
authors.lastname: Davido
authors.affiliation: Infectious Disease Department, Rouen University Hospital, 1 Rue de Germont, 76031, Rouen, France.
authors.forename: M
authors.initials: M
authors.lastname: Etienne
authors.affiliation: Pharmacy Department, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France.
authors.forename: F
authors.initials: F
authors.lastname: Bouchand
authors.affiliation: Emergency Department, Toulouse Rangueil University Hospital, 1, Avenue du Professeur Jean Poulhès, 31050, Toulouse, France.
authors.forename: A
authors.initials: A
authors.lastname: Raynaud-Lambinet
authors.affiliation: Internal Medicine Department, Hotel-Dieu University Hospital, 1 Place du Parvis de Notre-Dame, 75004, Paris, France.
authors.forename: E
authors.initials: E
authors.lastname: Aslangul-Castier
authors.affiliation: Emergency Department, Hotel-Dieu University Hospital, 1 Place du Parvis de Notre-Dame, 75004, Paris, France.
authors.forename: T A
authors.initials: TA
authors.lastname: Szwebel
authors.affiliation: Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France.
authors.forename: C
authors.initials: C
authors.lastname: Duran
authors.affiliation: Emergency Department, Hotel-Dieu University Hospital, 1 Place du Parvis de Notre-Dame, 75004, Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Der Sahakian
authors.affiliation: Emergency Department, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France.
authors.forename: C
authors.initials: C
authors.lastname: Jordy
authors.affiliation: Emergency Department, Versailles Hospital, 177 Rue de Versailles, 78150, Le Chesnay, France.
authors.forename: X
authors.initials: X
authors.lastname: Ranchoux
authors.affiliation: Emergency Department, University HEGP Hospital, 20 Rue Leblanc, 75015, Paris, France.
authors.forename: N
authors.initials: N
authors.lastname: Sembach
authors.affiliation: Emergency Department, Foch Hospital, 40 Rue Worth, 92151, Suresnes, France.
authors.forename: E
authors.initials: E
authors.lastname: Mathieu
authors.affiliation: Emergency Department, University HEGP Hospital, 20 Rue Leblanc, 75015, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Davido
authors.affiliation: Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint-Quentin University, 104 Bd Raymond Poincaré, 92380, Garches, France.|UMR 1181, INSERM, Institut Pasteur, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Salomon
authors.affiliation: Infectious Disease Department, Bretonneau University Hospital, Rabelais University, 2 Boulevard Tonnellé, 37000, Tours, France.
authors.forename: L
authors.initials: L
authors.lastname: Bernard
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004927:Escherichia coli Infections / Q000188:drug therapy; D005260:Female; D024841:Fluoroquinolones / Q000008:administration & dosage*; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011704:Pyelonephritis / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones