A randomized trial failed to prove the noninferiority of oral antibiotic monotherapy, relative to sequential intravenous and oral therapy, but evidence supporting oral treatment alone as an option is accumulating.
Children with acute pyelonephritis typically receive intravenous (IV) antibiotic therapy as initial standard treatment. At 10 pediatric centers in France, researchers randomized 171 children (age range, 1–36 months) with their first case of acute pyelonephritis to receive oral cefixime for 10 days or IV ceftriaxone for 4 days followed by oral cefixime for 6 days (sequential antibiotics). All participants had an abnormal dimercaptosuccinic acid (DMSA) scintigraphy result within 8 days of diagnosis and an elevated serum procalcitonin concentration.
Among 96 patients in a per-protocol analysis, the incidence of renal scarring, measured with DMSA scintigraphy 6 to 8 months after treatment, was 31% in the oral cefixime-alone group and 27% in the …
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DisclosuresGrant/Research SupportNIH Institutional Clinical and Translational Science Award; Agency for Healthcare Research and Quality National Center for Pediatric Practice Based Research Learning; Patient-Centered Outcomes Research Institute
Editorial BoardsCurrent Problems in Pediatric Adolescent Healthcare
Leadership Positions in Professional Societies College of Physicians of Philadelphia (Board of Trustees)
DisclosuresGrant/Research SupportNIH Institutional Clinical and Translational Science Award; Agency for Healthcare Research and Quality National Center for Pediatric Practice Based Research Learning; Patient-Centered Outcomes Research Institute
Editorial BoardsCurrent Problems in Pediatric Adolescent Healthcare
Leadership Positions in Professional Societies College of Physicians of Philadelphia (Board of Trustees)