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Comparison of the effectiveness of prescribing oral antibiotics and stepwise antibiotic therapy in the treatment of acute pyelonephritis

The aim of a prospective multicenter study conducted in France was to confirm the comparable effectiveness of oral and progressive antibiotic therapy for acute pyelonephritis in the prevention of scarring changes in the renal parenchyma in children with acute pyelonephritis and acute renal damage confirmed by scintigraphy.

The study involved children aged 1 to 36 months with the first episode of acute pyelonephritis, with a concentration of procalcitonin in blood serum greater than 0.5 ng / ml, without a history of chronic renal disease, without pathological changes ultrasound. Study participants were randomized into two groups: patients in the first group received cefixime orally for 10 days, patients in the second group received ceftriaxone intravenously for 4 days, followed by oral administration of cefixime for 6 days. If acute renal injury was detected by dimercaptosuccinic acid scintigraphy, repeated control scintigraphy was performed after 6 to 8 months.

The study did not reveal any significant differences between the two groups for each of the clinical characteristics studied. Of the 171 study participants, pathological changes based on the results of primary scintigraphy were detected in 119 children; Ninety-six children underwent scintigraphy to detect scar changes in the renal parenchyma. The frequency of scar changes in the renal parenchyma was 30.8% in the group of patients who received oral antibiotic therapy and 27.3% in children who were on progressive antibiotic therapy.

Thus, statistically, it was not possible to confirm the fact that the appointment of inward antibiotics for acute pyelonephritis is not inferior to the sequential scheme. However, the results obtained in this study are consistent with data from previous studies, which confirms the possibility of using an oral antibiotic regimen for the treatment of the first episode of acute pyelonephritis in infants and young children.