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European Journal of Pediatrics

, Volume 167, Issue 9, pp 1037–1047 | Cite as

Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis

  • Thomas J. Neuhaus
  • Christoph Berger
  • Katja Buechner
  • Paloma Parvex
  • Gian Bischoff
  • Philippe Goetschel
  • Daniela Husarik
  • Ulrich Willi
  • Luciano Molinari
  • Christoph Rudin
  • Alain Gervaix
  • Urs Hunziker
  • Sergio Stocker
  • Eric Girardin
  • David NadalEmail author
Original Paper

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

Ceftibuten Child Pyelonephritis Scintigraphy Out-patient 

Abbreviations

CRP

C-reactive protein

DMSA

Dimercaptosuccinic acid

VUR

Vesico-ureteric reflux

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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Thomas J. Neuhaus
    • 1
    • 2
  • Christoph Berger
    • 3
  • Katja Buechner
    • 3
  • Paloma Parvex
    • 6
  • Gian Bischoff
    • 7
  • Philippe Goetschel
    • 8
  • Daniela Husarik
    • 9
  • Ulrich Willi
    • 4
  • Luciano Molinari
    • 5
  • Christoph Rudin
    • 10
  • Alain Gervaix
    • 6
  • Urs Hunziker
    • 7
  • Sergio Stocker
    • 2
  • Eric Girardin
    • 6
  • David Nadal
    • 3
    Email author
  1. 1.Department of NephrologyUniversity Children’s Hospital ZurichZurichSwitzerland
  2. 2.Department of General PaediatricsUniversity Children’s Hospital ZurichZurichSwitzerland
  3. 3.Department of Infectious DiseasesUniversity Children’s Hospital ZurichZurichSwitzerland
  4. 4.Department of RadiologyUniversity Children’s Hospital ZurichZurichSwitzerland
  5. 5.Child Development CenterUniversity Children’s Hospital ZurichZurichSwitzerland
  6. 6.Department of NephrologyUniversity Children’s Hospital GenevaGeneva 14Switzerland
  7. 7.Department of PaediatricsCantonal Hospital WinterthurWinterthurSwitzerland
  8. 8.Department of PaediatricsCity Hospital Zurich-TriemliZurichSwitzerland
  9. 9.Department of Nuclear MedicineUniversity Hospital ZurichZurichSwitzerland
  10. 10.Department of NephrologyUniversity Children’s Hospital BasleBasleSwitzerland

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