N. Sannier et al., Ambulatory management of acute pyelonephritis in children. Experience in apediatric emergency department., ANN PEDIAT, 46(2), 1999, pp. 104-112
Background:evaluation of ambulatory management with a single parenteral ant
ibiotic treatment for uncomplicated pyelonephritis in children. Population
and methods: Retrospectively analysis of 225 children with a suspicion of u
ncomplicated pyelonephritis between 1/1/95 to 30/6/96. The children were tr
eated with a single dose per day of ceftriaxone for four days, followed by
ten days of oral antibiotherapy. Fever duration, repeat urine culture, cyst
ourethrography, surgical treatment and relapse were monitored. Results: 130
children from I month to 15 years met criteria commonly accepted for pyelo
nephritis diagnosis. After 12 months of age pyelonephritis was more common
in girls and 43% of the population were younger than 1 year. E, coli. was i
solated in 94% of them. Fever disappeared and urine was sterilized within 7
2 hours. Cystourethrography was undertaken in 112 cases. One posterior uret
hral valves and 43 vesicoureteral reflux (38%) were discovered. A third of
them was surgically repaired during follow up. One relapse occured 3 weeks
later. Follow-up from 9 to 27 month was possible for 104 children (80%). Co
nclusion : When families fully understand the treatment, ambulatory managem
ent of common pyelonephritis with one parenteral antibiotic is safe, on con
dition families agreed to the treatment modes. To chose between one or two
antibiotic strategies, further studies with early and late DMSA renal scans
are needed to detect renal scar incidence.