Pyelonephritis Clinical Trial
Official title:
Randomised Controlled Trial on Efficacy and Safety of Short Term Versus Long Term Antibiotic Therapy for Pyelonephritis in Childhood.
The purpose of this study is to evaluate the efficacy of oral ceftibuten for 7 days versus
10 days in acute pyelonephritis in children.
The main hypothesis is that the ceftibuten for 7 days will be not inferior to ceftibuten 10
days in the rate of renal scarring at 6-12 months.
Acute pyelonephritis is one of the most common serious bacterial infections in childhood,
particularly in young children, with an estimated prevalence in febrile infants of 5.3%. It
has been considered an important risk factor for the development of renal scarring, and
renal insufficiency. More recently the long term outcomes of pyelonephritis has ameliorated,
probably because of prompt diagnosis and therapy, and the importance of urinary tract
infection as a risk factor for renal insufficiency has been questioned.
Nevertheless, the optimal type and duration of antibiotic therapy for acute uncomplicated
pyelonephritis in children is not established yet.
There is a general agreement that children who are dehydrated, unable to drink, or in whom
sepsis is possible, should be admitted to hospital for intravenous antibiotic treatment.
Outside this conditions, evidence suggest that children with acute pyelonephritis can be
treated effectively with cefixime, ceftibuten or amoxycillin/clavulanic acid. given orally
(1).
A recently updated Cochrane review on antibiotic treatment for acute pyelonephritis in
children identified twenty three studies (3407 children). No significant differences were
found in persistent renal 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: WMD 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 renal 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.
Authors concluded that children with acute pyelonephritis can be treated effectively with
oral antibiotics (cefixime, ceftibuten and amoxycillin/clavulanic acid) or with short
courses (2 to 4 days) of IV therapy followed by oral therapy.
Oral treatment also is easier to use and does not require admission to hospital, leading to
reduced costs.
Nevertheless, the exact duration of oral therapy is not established. Current guidelines
recommend 7-14 days course of broad-spectrum antibiotics capable of reaching significant
renal levels.
The objective of our study is to evaluate if oral ceftibuten for 7 days is equally effective
as oral ceftibuten for 10 days in acute pyelonephritis in children.
This is a non-inferiority randomised controlled trial to determine whether a short term
therapy with ceftibuten ( 7 days) will be therapeutically similar to a long term therapy (
10 days), measuring as major outcome the prevalence of renal scars.
;
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment
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