PYELONEPHRITIS IN PREGNANCY - ONCE-A-DAY CEFTRIAXONE VERSUS MULTIPLE DOSES OF CEFAZOLIN - A RANDOMIZED, DOUBLE-BLIND TRIAL

OBJECTIVE: The purpose of this study was to compare the efficacy of a single daily dose of intravenous ceftriaxone with that of multiple-dos e cefazolin in the treatment of acute pyelonephritis in pregnancy. STU DY DESIGN: This was a double-blind, randomized, clinical trial. Patien ts admitted to the hospital with the diagnosis of acute pyelonephritis in pregnancy were enrolled and randomized according to a computer-gen erated randomization schedule. The study group received a single daily 1 gm dose of ceftriaxone intravenously along with two additional dose s of normal saline solution. The comparison group received three daily 2 gm doses of cefazolin intravenously. All infusions were given on an an 8-hour schedule. Treatments were continued until the patient becam e afebrile. Each patient was discharged from the hospital on a regimen of appropriate oral antibiotics as directed by urine culture and sens itivities. At follow-up visits test-of-cure cultures were obtained. RE SULTS: During the 2-year study period, 178 patients were randomized: 8 8 received cefazolin and 90 ceftriaxone. Patient demographics and pres enting signs and symptoms were similar in both groups. No differences were noted between the groups regarding days of febrile morbidity, len gth of hospital stay, or treatment failures. CONCLUSIONS: Daily single -dose intravenous ceftriaxone is as effective as multiple-dose cefazol in in the treatment of patients with acute pyelonephritis during pregn ancy.