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Evidence summaries

Antibiotics for Acute Pyelonephritis in Children

Oralcefixime or amoxycillin/clavulanic acid or short courses (2-4 days) of IV therapy followed by oral therapy are both effective for children with acute pyelonephritis. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 27 studies with a total of 4 452 subjects. No significant differences were found in persistent renal damage at 6 to 12 months (RR 0.82, 95% CI 0.59 to 1.12, 4 studies, n=943) or in duration of fever (WMD 2.05, 95% CI -0.84 to 4.94, 2 studies n=808), or in persistent UTI at 72 hours after commencing therapy (RR 1.10, 95% CI 0.07 to 17.41; 2 studies, n=542) between oral cefixime or amoxycillin/clavulanic acid therapy (10 -14 days) and IV therapy with cefotaxime or ceftriaxone (three days) followed by oral therapy (10 days). In addition no significant differences in efficacy were found between daily and thrice daily administration of aminoglycosides (one trial, 179 children, persistent symptoms at three days: RR 1.98, 95% CI 0.37 to 10.53). Adverse events were mild and uncommon and rarely resulted in discontinuation of treatment.

    References

    • Strohmeier Y, Hodson EM, Willis NS et al. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev 2014;(7):CD003772. [PubMed]

Primary/Secondary Keywords