Article Summary: Antibiotics for acute pyelonephritis in children

This article is a meta-analysis that evaluates the benefits and harms of antibiotics used to treat children with acute pyelonephritis. Researchers evaluated different antibiotics, dosing regimens, duration, and different routes of administration. 

Randomized and quasi-randomised control trials of children aged 0-18 years with proven UTI and acute pyelonephritis were selected for the study. 27 studies of 4,452 children were included, and the settings were inpatient and outpatient. 

Interventions included short duration (3-4 days) versus long duration (7-14 days) IV therapy, different dosing regimens of aminoglycosides (daily versus 8 hourly), and 3rd generation cephalosporin versus other antibiotics. 

Outcomes studied included persistent bacteriuria after treatment, recurrent UTI after end of therapy, persistent symptoms after end of treatment, and renal damage at 3-6 months

For the treatment of acute pyelonephritis, it was concluded that oral antibiotics alone are as effective as a short course of IV antibiotics followed by oral therapy for a total duration of 10-14 days. If IV therapy with aminoglycosides is chosen, a single daily dosing is effective and safe to use.

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