Ambulatory management of acute pyelonephritis in children. Experience in apediatric emergency department.

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.