ASSESSMENT OF THE EFFICACY AND COST EFFIC IENCY OF 2 STRATEGIES IN THE TREATMENT OF ACUTE PYELONEPHRITIS IN CHILDREN - ORAL CEFIXIME OR PARENTERAL CEFTRIAXONE AFTER AN INITIAL IV COMBINATION THERAPY

The efficacy, safety, and costs of 4 days of parenteral therapy with c eftriaxone and netilmicin followed by either oral therapy with cefixim e or parenteral therapy with ceftriaxone for 6 days for the treatment of acute pyelonephritis (APN) in children were assessed in this open, hospital multicenter, randomized trial, APN was considered in children in-patients, aged 6 months to 10 years, with no history of abnormal u rinary tract, fever 38 degrees C, significant bacteriuria, abnormal WB C count and CRP value, The end point was clinical and microbiological cure at D12 and D30 for those with success at D12 (48 h. after the end of the second therapy). Sixty three patients were treated by cefixime and 65 by ceftriaxone as a seconde therapy. Results were as follow: b oth treatments were equivalent at D12 and D30 with a success rate of 9 8% and 100% for cefixime and 100% and 96% for ceftriaxone at D12 and D 30 respectively. Side effects were reported for 13% and 11% of patient s in cefixime and ceftriaxone groups, respectively, E. coli was the mo st common pathogen isolated in both groups (93%) with a resistance rat e to amoxicillin and amoxicillin/clavulanate reaching 45% and 24% resp ectively. No strain exhibited resistance to third generation cephalosp orins. There was a significant difference in the average treatment cos t between both groups. In cefixime group the expenses reached 513 Fren ch Francs (176-896) while in the other group it reached 3,545 French F rancs (2478-4673).