Antibiotics for acute pyelonephritis in children

  • Review
  • Intervention

Authors

  • Elisabeth M Hodson,

    Corresponding author
    1. b) School of Public Health, The University of Sydney, a) Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
    • Elisabeth M Hodson, a) Centre for Kidney Research, The Children's Hospital at Westmead, b) School of Public Health, The University of Sydney, Locked Bag 4001, Westmead, NSW, 2145, Australia. Elisah@chw.edu.au.

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  • Narelle S Willis,

    1. The Children's Hospital at Westmead, Cochrane Renal Group, Centre for Kidney Research, Westmead, NSW, Australia
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  • Jonathan C Craig

    1. (b) School of Public Health, The University of Sydney, (a) Cochrane Renal Group, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
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Abstract

Background

Urinary tract infection (UTI) is one of the most common bacterial infection in infants. The most severe form of UTI is acute pyelonephritis, which results in significant acute morbidity and may cause permanent kidney damage. Published guidelines recommend treatment of acute pyelonephritis initially with intravenous (IV) therapy followed by oral therapy for seven to 14 days though there is no consensus on the duration of either IV or oral therapy.

Objectives

To determine the benefits and harms of different antibiotic regimens for the treatment of acute pyelonephritis in children.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, reference lists of articles and conference proceedings without language restriction.
Date of most recent search: December 2006.

Selection criteria

Randomised and quasi-randomised controlled trials comparing different antibiotic agents, routes, frequencies or durations of therapy in children aged 0 to 18 years with proven UTI and acute pyelonephritis were selected.

Data collection and analysis

Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes or mean difference (MD) for continuous data with 95% confidence intervals (CI).

Main results

Twenty three studies (3407 children) were eligible for inclusion. No significant differences were found in persistent kidney damage at six to 12 months (824 children: RR 0.80, 95% CI 0.50 to 1.26) or in duration of fever (808 children: MD 2.05, 95% CI -0.84 to 4.94) between oral antibiotic therapy (10 to 14 days) and IV therapy (3 days) followed by oral therapy (10 days). Similarly no significant differences in persistent kidney damage (3 studies, 341 children: RR 1.13, 95% CI 0.86 to 1.49) were found between IV therapy (3 to 4 days) followed by oral therapy and IV therapy for 7 to 14 days. No significant differences in efficacy were found between daily and thrice daily administration of aminoglycosides (179 children, persistent symptoms at 3 days: RR 1.98, 95% CI 0.37 to 10.53).

Authors' conclusions

These results suggest that children with acute pyelonephritis can be treated effectively with oral antibiotics (cefixime, ceftibuten and amoxicillin/clavulanic acid) or with short courses (2 to 4 days) of IV therapy followed by oral therapy. If IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective. Studies are required to determine the optimal total duration of therapy.

摘要

背景

小孩急性腎盂腎炎抗生素的治療

泌尿道感染 (UTI) 是嬰兒常見的細菌感染疾病之一,最嚴重的泌尿道感染的形式是腎盂腎炎,其會對腎臟導致永久的傷害。雖然對於針劑治療或口服抗生素治療時間並無共識,但已發表的治療指引建議一開始先使用針劑治療,接下來再以口服的抗生素治療共維持7 – 14天。

目標

決定針對小孩的腎盂腎炎使用不同抗生素治療的利與弊。

搜尋策略

我們無語言的限制調查Cochrane Contral Register of Contrlled Trials, MEDLINE, EMBASE及相關文章與研討會的參考文獻,最近搜尋的日期:2006年12月。

選擇標準

針對年齡介於0 – 18歲的小孩,採用證實有泌尿道感染及腎盂腎炎的隨機及半隨機對照試驗,並比較使用不同抗生素製劑、途徑、頻率或治療時間。

資料收集與分析

兩位作者分別獨立的評估研究品質並摘錄資料,使用隨機作用的模式來做統計分析,相關的結果以95% 的信賴區間 (CI) 預後的相對風險性來呈現。

主要結論

總共23個研究 (包含3407位小孩) 被選入,在口服抗生素 (10 – 14天) 或靜脈針劑注射3天再加上口服抗生素組10天對於在 6 – 12月間所造成的腎傷害 (824位小孩:平均差異0.8,95%信賴區間0.5至1.26) 或發燒的期間 (808位小孩,平均差異:2.05,95%信賴區間: −0.84至4.94) 均無顯著差異。同樣地,在比較靜脈針劑注射加上口服抗生素組及靜脈針劑組 (7至14天) ,發現對於持續的腎傷害並無差別 (3個研究,341位小孩,相對風險1.13,95%信賴區間0.86至1.49) 。每天一次與每天三次使用胺基糖甘類抗生素 (Aminoglycoside) 對於治療效果也無差異 (179位小孩,3天持續有症狀,相對風險1.98,95%信賴區間0.37至10.53) 。

作者結論

這些結論顯示對於小孩,口服抗生素或短時間 (2 – 4天) 針劑加上口服抗生素可以有效地治療急性腎盂腎炎,如果選擇針劑治療,每天一次單一劑量Aminoglycoside是安全且有效的。至於,最適當的總治療時間仍須更多研究來證實。

翻譯人

本摘要由馬偕醫院郭馨仁翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

口服抗生素治療和針劑治療合併口服抗生素治療,對於治療小孩腎臟感染一樣有效。急性腎盂腎炎指腎臟感染,是最嚴重的泌尿道感染。可以造成嬰孩發燒,嘔吐,胃痛,躁動不安,餵食量降低。剛開始使用針劑抗生素治療,然後使用口服抗生素治療7到14天,以根除感染預防腎臟受傷。這總結總共23個研究 (包含3407位小孩) ,建議小孩急性腎盂腎炎,可以被口服抗生素 (cefixime, ceftibuten or amoxycillin/clavulanic acid) 有效治療,或者使用短期針劑抗生素治療 (2到4天) 後,使用口服抗生素治療。如果選用針劑抗生素治療,可以合用每日單一劑量的aminoglycosides,是安全有效的。

Plain language summary

Oral antibiotics may be as effective as the combination of injection and oral antibiotics for kidney infections in children

Acute pyelonephritis refers to infection of the kidneys and is the most severe form of urinary tract infection (UTI). It causes high fever, vomiting, stomach pain, irritability and poor feeding in infants. Usual treatment is antibiotics given first by injection (IV) and then orally for 7 to 14 days to clear the infection and prevent kidney damage. This review identified 23 studies (3407 children). These results suggest that children with acute pyelonephritis can be treated effectively with cefixime, ceftibuten or amoxicillin/clavulanic acid given orally or with short courses (2 to 4 days) of IV therapy followed by oral therapy. If IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective.

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