ARE CURRENT PARENTERAL TREATMENT DURATION S FOR ACUTE PYELONEPHRITIS IN PEDIATRIC-PATIENTS TOO LONG

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.