Antibiotics for acute pyelonephritis in children - results of the Cochrane systematic review

Urinary tract infections are one of the most common forms of infectious disease in children. The most serious form of UTI is pyelonephritis, which causes both high rates of acute morbidity and long-term persistent kidney damage. Guidelines published as a treatment for acute pyelonephritis suggest intravenous administration of the drug with a subsequent transition to oral administration, while the recommended duration of treatment is 7 to 14 days. At the same time, there is still no consensus on the duration of intravenous and oral therapy.

The objective of the Cochrane systematic review was to identify the advantages and disadvantages of various antibacterial regimes for acute pyelonephritis in children.

The search was performed in the Cochrane Central Register of Controlled Studies (CENTRAL), the MEDLINE, EMBASE electronic databases, articles and conference papers without linguistic restrictions published before December 2006.

All randomized and partially randomized controlled trials were selected to compare different antibacterial drugs, routes of administration, frequency of administration, or duration of treatment in children under 18 years of age with proven cases of UTI and acute pyelonephritis.

The quality of the studies and the data obtained were assessed by two independent experts. Statistical analysis was performed using a random effects model. The results were presented as a risk ratio for the dichotomous results and as a weighted average difference for the continuous data with a 95% confidence interval.

23 studies were selected for inclusion in the study (3295 children in total). Statistically significant differences in rates of persistent kidney damage within 6 months (2 studies, 424 children: risk ratio [RR] 0.87, 95% confidence interval [CI] 0.35-2.16) or duration of fever (2 studies, 693 children: weighted average difference of 1.54, 95% CI 1.67-4.76) between the administration of oral antibiotics for 10-14 days and by route intravenous (3 days) with subsequent transition to oral administration for 10 days was not detected. There was also no statistically significant difference in the occurrence of persistent kidney damage (3 studies, 341 children: RR 1.13, 95% CI 0.86-1.49) with intravenous therapy for 3- 4 days, followed by the transition to taking the drug inside, the appointment of antibiotic and intravenous therapy for 7-14 days. During the meta-analysis, there was no statistically significant difference in the evaluation of the effectiveness of the single and triple administration of aminoglycosides during the day (1 study, 179 children, persistent symptoms on the third day of treatment: RR 1.98, 95% CI 0.37-10.53).

The data obtained indicate that children with acute pyelonephritis can be treated effectively with antibiotics for oral administration (cefixime, ceftibutene or amoxicillin / clavulanate), as well as short periods of intravenous therapy (2-4 days), followed by a switch to oral administration. When choosing an intravenous antibiotic route, a single administration of aminoglycosides is effective and safe. More studies are needed to determine the optimal overall duration of antibiotic therapy.