ANTIBIOTIC TREATMENT OF ACUTE PYELONEPHRITIS

Key words: Acute pyelonephritis, Randomised controlled trials, Local uropathogens, Antibiotics

This is a review article about antibiotic treatment of acute pyelonephritis (APN). Diagnosis of APN requires high fever and urine test positive for leukocytes and bacteria. The major decisions about treatment that are to be made concern the use of antibiotics. Infants aged 1 month or less with APN require intravenous (IV) antibiotics because of the high prevalence of concomitant bacteraemia (about 10%). Ceftriaxone or aminoglycosides are the chosen medicines. After the first month of life, oral antibiotics are as safe and effective as IV antibiotics in children with a clinical diagnosis of APN. There is no evidence to support the practice of giving a single dose of parenteral antibiotics in addition to a standard course of orally administered antibiotics. IV treatment should be preserved for children who are seriously ill, or who fail oral treatment because of persistent vomiting. Since Escherichia coli is the most common pathogen (about 90% of cases), empirical treatment with a β-lactam oral antibiotic (cephalosporines or amoxicillin-clavulanic acid) is indicated. The choice of specific antibiotics should be based on data about local uropathogens. Trials are required to determine the optimal total duration of therapy.