Short-term Antibiotic Therapy for Pyelonephritis in Childhood

Pyelonephritis Clinical Trial

— STUTI  

Official title:

Randomised Controlled Trial on Efficacy and Safety of Short Term Versus Long Term Antibiotic Therapy for Pyelonephritis in Childhood.

Clinical Trial Details — Status: Terminated

Administrative data

• NCT number: NCT00724256
• Other study ID #: UTI_62-2006
• Status: Terminated
• Phase: Phase 3
• First received: July 18, 2008
• Last updated: February 15, 2012
• Start date: July 2006
• Est. completion date: July 2010

Study information

• Verified date: February 2012
• Source: IRCCS Burlo Garofolo
• Contact: n/a
• Is FDA regulated: No
• Health authority: Italy: Ministry of HealthItaly: National Monitoring Centre for Clinical Trials - Ministry of Health
• Study type: Interventional

Clinical Trial Summary

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.

Description:

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.

Recruitment information / eligibility

• Status: Terminated
• Enrollment: 36
• Est. completion date: July 2010
• Est. primary completion date: July 2009
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 1 Month to 5 Years

Eligibility

Inclusion Criteria:

• Children aged 1 month to 5 years, with a first episode of pyelonephritis.

Exclusion Criteria:

• Children less than 1 month, or older than 5 years.

• Relapse of pyelonephritis.

• Sepsis and/or vomiting, or other conditions where it's impossible to administer an oral therapy.

• Allergy to ceftibuten.

• Previous antibiotic therapy for the same infection.

• Long term antibiotic prophylaxis with an antibiotic of the same class, if laboratory antibiotic resistance is shown.

• Children with uncontrolled other disease.

• Complicated pyelonephritis (abscess).

Study Design

Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Treatment

Related Conditions & MeSH terms

• Pyelonephritis

Intervention

Drug:
• ceftibuten
ceftibuten 9mg/kg once a day for 7 days.
• ceftibuten
ceftibuten 9mg/kg once a day for 10 days.

Locations

Country	Name	City	State
Italy	Institute for Child Health Burlo Garofolo	Triest

Sponsors (1)

Lead Sponsor	Collaborator
IRCCS Burlo Garofolo

Country where clinical trial is conducted

Italy, 

References & Publications (1)

Hodson EM, Willis NS, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003772. Review. Update in: Cochrane Database Syst Rev. 2014;7:CD003772. — View Citation

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Rate of renal SCAR		6-12 month from urinary tract infection	No
Secondary	Relapses		up to12 months	No
Secondary	Adverse effects of drug therapy		10 days	Yes