I. Sermet et al., ARE CURRENT PARENTERAL TREATMENT DURATION S FOR ACUTE PYELONEPHRITIS IN PEDIATRIC-PATIENTS TOO LONG, Annales de pediatrie, 45(1), 1998, pp. 35-42
None of the treatment protocols currently used to treat acute pyelonep
hritis in children has been validated by prospective studies, Antimicr
obials that have a bactericidal effect on sensitive strains and that a
ccumulate in the kidneys in levels considerably higher than the MTCs o
f the most common causative organisms include aminopenicillins (alone
or with clavulanic acid)!, second-or third-generation cephalosporins,
carbapenems, monobactams, ureidopenicillins, carboxypenicillins, amino
glycosides, trimethoprime-sulfamethoxazole, and quinolones, However, q
uinolones should not be used during the growth period, In patients you
nger than 18 months, and in those who have congenital urinary tract ab
normalities or evidence of severe sepsis, a third-generation cephalosp
orin and an aminoglycoside should be given parenterally (consensus con
ference), Other patients can be treated by two antimicrobials via the
parenteral route until urine cultures revert to negative, followed by
a single antimicrobial by the oral route; alternatively, a single oral
antimicrobial can be used from the outset. Duration of parenteral the
rapy is not well standardized but is usually ten days. Reducing this d
uration would have a number of beneficial effects including cost swing
s, a decrease in adverse experiences, improved compliance and acceptab
ility, and a decreased risk of selection of resistant bacteria. Antimi
crobials that persist in the renal parenchyma (aminoglycosides, fluoro
quinolones) or urine (sulfonamides, betalactams) could perhaps be used
for shorter periods of time. Published studies fail to clarify this p
oint because of methodological shortcomings. A protocol for investigat
ing shorter parenteral antimicrobial treatments is suggested.