Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis.
Details
Serval ID
serval:BIB_B7ECE615E458
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis.
Journal
European Journal of Pediatrics
ISSN
1432-1076[electronic]
Publication state
Published
Issued date
2008
Volume
167
Number
9
Pages
1037-1047
Language
english
Abstract
The hypothesis was tested that oral antibiotic treatment in children with acute pyelonephritis and scintigraphy-documented lesions is equally as efficacious as sequential intravenous/oral therapy with respect to the incidence of renal scarring. A randomised multi-centre trial was conducted in 365 children aged 6 months to 16 years with bacterial growth in cultures from urine collected by catheter. The children were assigned to receive either oral ceftibuten (9 mg/kg once daily) for 14 days or intravenous ceftriaxone (50 mg/kg once daily) for 3 days followed by oral ceftibuten for 11 days. Only patients with lesions detected on acute-phase dimercaptosuccinic acid (DMSA) scintigraphy underwent follow-up scintigraphy. Efficacy was evaluated by the rate of renal scarring after 6 months on follow-up scintigraphy. Of 219 children with lesions on acute-phase scintigraphy, 152 completed the study; 80 (72 females, median age 2.2 years) were given ceftibuten and 72 (62 females, median age 1.6 years) were given ceftriaxone/ceftibuten. Patients in the intravenous/oral group had significantly higher C-reactive protein (CRP) concentrations at baseline and larger lesion(s) on acute-phase scintigraphy. Follow-up scintigraphy showed renal scarring in 21/80 children treated with ceftibuten and 33/72 with ceftriaxone/ceftibuten (p = 0.01). However, after adjustment for the confounding variables (CRP and size of acute-phase lesion), no significant difference was observed for renal scarring between the two groups (p = 0.2). Renal scarring correlated with the extent of the acute-phase lesion (r = 0.60, p < 0.0001) and the grade of vesico-ureteric reflux (r = 0.31, p = 0.03), and was more frequent in refluxing renal units (p = 0.04). The majority of patients, i.e. 44 in the oral group and 47 in the intravenous/oral group, were managed as out-patients. Side effects were not observed. From this study, we can conclude that once-daily oral ceftibuten for 14 days yielded comparable results to sequential ceftriaxone/ceftibuten treatment in children aged 6 months to 16 years with DMSA-documented acute pyelonephritis and it allowed out-patient management in the majority of these children.
Keywords
Administration, Oral, Adolescent, Anti-Bacterial Agents/administration & dosage, Anti-Bacterial Agents/therapeutic use, Ceftriaxone/administration & dosage, Ceftriaxone/therapeutic use, Cephalosporins/administration & dosage, Cephalosporins/therapeutic use, Child, Child, Preschool, Drug Administration Schedule, Female, Humans, Infant, Injections, Intravenous, Male, Pyelonephritis/drug therapy, Pyelonephritis/pathology, Technetium Tc 99m Dimercaptosuccinic Acid
Pubmed
Web of science
Create date
12/01/2010 10:56
Last modification date
20/08/2019 16:26