Skip to main content
NCBI home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2001 Mar;84(3):241–246. doi: 10.1136/adc.84.3.241

Randomised controlled trial of three day versus 10 day intravenous antibiotics in acute pyelonephritis: effect on renal scarring

D Benador 1, T Neuhaus 1, J Papazyan 1, U Willi 1, I Engel-Bicik 1, D Nadal 1, D Slosman 1, B Mermillod 1, E Girardin 1
PMCID: PMC1718672  PMID: 11207174

Abstract

BACKGROUND—Acute pyelonephritis often leaves children with permanent renal scarring.
AIMS—To compare the prevalence of scarring following initial treatment with antibiotics administered intravenously for 10 or three days.
METHODS—In a prospective two centre trial, 220 patients aged 3 months to 16 years with positive urine culture and acute renal lesions on initial DMSA scintigraphy, were randomly assigned to receive intravenous ceftriaxone (50 mg/kg once daily) for 10 or three days, followed by oral cefixime (4 mg/kg twice daily) to complete a 15 day course. After three months, scintigraphy was repeated in order to diagnose renal scars.
RESULTS—Renal scarring developed in 33% of the 110 children in the 10 day intravenous group and 36% of the 110 children in the three day group. Children older than 1 year had more renal scarring than infants (42% (54/129) and 24% (22/91), respectively). After adjustment for age, sex, duration of fever before treatment, degree of inflammation, presence of vesicoureteric reflux, and the patients' recruitment centres, there was no significant difference between the two treatments on renal scarring. During follow up, 15 children had recurrence of urinary infection with no significant difference between the two treatment groups.
CONCLUSION—In children with acute pyelonephritis, initial intravenous treatment for 10 days, compared with three days, does not significantly reduce the development of renal scarring.



Full Text

The Full Text of this article is available as a PDF (150.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Benador D., Benador N., Slosman D. O., Nusslé D., Mermillod B., Girardin E. Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis. J Pediatr. 1994 Jan;124(1):17–20. doi: 10.1016/s0022-3476(94)70248-9. [DOI] [PubMed] [Google Scholar]
  2. Benador D., Benador N., Slosman D., Mermillod B., Girardin E. Are younger children at highest risk of renal sequelae after pyelonephritis? Lancet. 1997 Jan 4;349(9044):17–19. doi: 10.1016/s0140-6736(96)06126-0. [DOI] [PubMed] [Google Scholar]
  3. Buyan N., Bircan Z. E., Hasanoğlu E., Oztürk E., Bayhan H., Rota S. The importance of 99mTc DMSA scanning in the localization of childhood urinary tract infections. Int Urol Nephrol. 1993;25(1):11–17. doi: 10.1007/BF02552249. [DOI] [PubMed] [Google Scholar]
  4. Connor J. P. DMSA scanning: a pediatric urologist's point of view. Pediatr Radiol. 1995 Nov;25 (Suppl 1):S50–S51. [PubMed] [Google Scholar]
  5. Coulter A. Partnerships with patients: the pros and cons of shared clinical decision-making. J Health Serv Res Policy. 1997 Apr;2(2):112–121. doi: 10.1177/135581969700200209. [DOI] [PubMed] [Google Scholar]
  6. Edwards A., Elwyn G. The potential benefits of decision aids in clinical medicine. JAMA. 1999 Aug 25;282(8):779–780. doi: 10.1001/jama.282.8.779. [DOI] [PubMed] [Google Scholar]
  7. Elwyn G., Edwards A., Kinnersley P. Shared decision-making in primary care: the neglected second half of the consultation. Br J Gen Pract. 1999 Jun;49(443):477–482. [PMC free article] [PubMed] [Google Scholar]
  8. Fleisher G. R., Rosenberg N., Vinci R., Steinberg J., Powell K., Christy C., Boenning D. A., Overturf G., Jaffe D., Platt R. Intramuscular versus oral antibiotic therapy for the prevention of meningitis and other bacterial sequelae in young, febrile children at risk for occult bacteremia. J Pediatr. 1994 Apr;124(4):504–512. doi: 10.1016/s0022-3476(05)83126-9. [DOI] [PubMed] [Google Scholar]
  9. Ginsburg C. M., McCracken G. H., Jr Urinary tract infections in young infants. Pediatrics. 1982 Apr;69(4):409–412. [PubMed] [Google Scholar]
  10. Glauser M. P., Lyons J. M., Braude A. I. Prevention of chronic experimental pyelonephritis by suppression of acute suppuration. J Clin Invest. 1978 Feb;61(2):403–407. doi: 10.1172/JCI108951. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Goldraich N. P., Goldraich I. H. Update on dimercaptosuccinic acid renal scanning in children with urinary tract infection. Pediatr Nephrol. 1995 Apr;9(2):221–227. doi: 10.1007/BF00860755. [DOI] [PubMed] [Google Scholar]
  12. Goldraich N. P., Ramos O. L., Goldraich I. H. Urography versus DMSA scan in children with vesicoureteric reflux. Pediatr Nephrol. 1989 Jan;3(1):1–5. doi: 10.1007/BF00859614. [DOI] [PubMed] [Google Scholar]
  13. Gordon I. Indications for 99mtechnetium dimercapto-succinic acid scan in children. J Urol. 1987 Mar;137(3):464–467. doi: 10.1016/s0022-5347(17)44069-9. [DOI] [PubMed] [Google Scholar]
  14. Hellerstein S. Urinary tract infections. Old and new concepts. Pediatr Clin North Am. 1995 Dec;42(6):1433–1457. doi: 10.1016/s0031-3955(16)40092-1. [DOI] [PubMed] [Google Scholar]
  15. Hellström M., Jacobsson B., Mårild S., Jodal U. Voiding cystourethrography as a predictor of reflux nephropathy in children with urinary-tract infection. AJR Am J Roentgenol. 1989 Apr;152(4):801–804. doi: 10.2214/ajr.152.4.801. [DOI] [PubMed] [Google Scholar]
  16. Hoberman A., Wald E. R., Hickey R. W., Baskin M., Charron M., Majd M., Kearney D. H., Reynolds E. A., Ruley J., Janosky J. E. Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics. 1999 Jul;104(1 Pt 1):79–86. doi: 10.1542/peds.104.1.79. [DOI] [PubMed] [Google Scholar]
  17. Jakobsson B., Berg U., Svensson L. Renal scarring after acute pyelonephritis. Arch Dis Child. 1994 Feb;70(2):111–115. doi: 10.1136/adc.70.2.111. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Jodal U. The natural history of bacteriuria in childhood. Infect Dis Clin North Am. 1987 Dec;1(4):713–729. [PubMed] [Google Scholar]
  19. Majd M., Rushton H. G. Renal cortical scintigraphy in the diagnosis of acute pyelonephritis. Semin Nucl Med. 1992 Apr;22(2):98–111. doi: 10.1016/s0001-2998(05)80085-6. [DOI] [PubMed] [Google Scholar]
  20. McCracken G. H., Jr Diagnosis and management of acute urinary tract infections in infants and children. Pediatr Infect Dis J. 1987 Jan;6(1):107–112. doi: 10.1097/00006454-198701000-00050. [DOI] [PubMed] [Google Scholar]
  21. Patel K., Charron M., Hoberman A., Brown M. L., Rogers K. D. Intra- and interobserver variability in interpretation of DMSA scans using a set of standardized criteria. Pediatr Radiol. 1993;23(7):506–509. doi: 10.1007/BF02012131. [DOI] [PubMed] [Google Scholar]
  22. Pohl H. G., Rushton H. G., Park J. S., Chandra R., Majd M. Adjunctive oral corticosteroids reduce renal scarring: the piglet model of reflux and acute experimental pyelonephritis. J Urol. 1999 Sep;162(3 Pt 1):815–820. doi: 10.1097/00005392-199909010-00067. [DOI] [PubMed] [Google Scholar]
  23. Rushton H. G., Majd M. Dimercaptosuccinic acid renal scintigraphy for the evaluation of pyelonephritis and scarring: a review of experimental and clinical studies. J Urol. 1992 Nov;148(5 Pt 2):1726–1732. doi: 10.1016/s0022-5347(17)37014-3. [DOI] [PubMed] [Google Scholar]
  24. Rushton H. G., Majd M., Jantausch B., Wiedermann B. L., Belman A. B. Renal scarring following reflux and nonreflux pyelonephritis in children: evaluation with 99mtechnetium-dimercaptosuccinic acid scintigraphy. J Urol. 1992 May;147(5):1327–1332. doi: 10.1016/s0022-5347(17)37555-9. [DOI] [PubMed] [Google Scholar]
  25. Rushton H. G. The evaluation of acute pyelonephritis and renal scarring with technetium 99m-dimercaptosuccinic acid renal scintigraphy: evolving concepts and future directions. Pediatr Nephrol. 1997 Feb;11(1):108–120. doi: 10.1007/s004670050243. [DOI] [PubMed] [Google Scholar]
  26. SMELLIE J. M., HODSON C. J., EDWARDS D., NORMAND I. C. CLINICAL AND RADIOLOGICAL FEATURES OF URINARY INFECTION IN CHILDHOOD. Br Med J. 1964 Nov 14;2(5419):1222–1226. doi: 10.1136/bmj.2.5419.1222. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Sfakianakis G. N., Sfakianaki E. D. Nuclear medicine in pediatric urology and nephrology. J Nucl Med. 1988 Jul;29(7):1287–1300. [PubMed] [Google Scholar]
  28. Stokland E., Hellström M., Jacobsson B., Jodal U., Sixt R. Renal damage one year after first urinary tract infection: role of dimercaptosuccinic acid scintigraphy. J Pediatr. 1996 Dec;129(6):815–820. doi: 10.1016/s0022-3476(96)70024-0. [DOI] [PubMed] [Google Scholar]
  29. Towle A., Godolphin W. Framework for teaching and learning informed shared decision making. BMJ. 1999 Sep 18;319(7212):766–771. doi: 10.1136/bmj.319.7212.766. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Winberg J., Bollgren I., Källenius G., Möllby R., Svenson S. B. Clinical pyelonephritis and focal renal scarring. A selected review of pathogenesis, prevention, and prognosis. Pediatr Clin North Am. 1982 Aug;29(4):801–814. doi: 10.1016/s0031-3955(16)34213-4. [DOI] [PubMed] [Google Scholar]
  31. Winter A. L., Hardy B. E., Alton D. J., Arbus G. S., Churchill B. M. Acquired renal scars in children. J Urol. 1983 Jun;129(6):1190–1194. doi: 10.1016/s0022-5347(17)52634-8. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES