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a Department of
Paediatrics, Cantonal University Hospital, 6 rue Willy Donzé, 1211 Geneva 14, Switzerland, b Department of Radiology, Cantonal University
Hospital, c Division of Medical Informatics, Cantonal
University Hospital, d University
Children's Hospital, Zurich, Switzerland, e Department of Radiology,
University Hospital, Zurich, Switzerland
Correspondence to: Dr Benador benador{at}bluewin.ch
Accepted 3 October
2000
BACKGROUND
Acute pyelonephritis
often leaves children with permanent renal scarring.
AIMSTo compare the prevalence of
scarring following initial treatment with antibiotics administered
intravenously for 10 or three days.
METHODSIn a prospective two centre
trial, 220 patients aged 3 months to 16 years with positive urine
culture and acute renal lesions on initial DMSA scintigraphy, were
randomly assigned to receive intravenous ceftriaxone (50 mg/kg once
daily) for 10 or three days, followed by oral cefixime (4 mg/kg twice
daily) to complete a 15 day course. After three months, scintigraphy
was repeated in order to diagnose renal scars.
RESULTSRenal scarring developed in
33% of the 110 children in the 10 day intravenous group and 36% of
the 110 children in the three day group. Children older than 1 year had
more renal scarring than infants (42% (54/129) and 24% (22/91),
respectively). After adjustment for age, sex, duration of fever before
treatment, degree of inflammation, presence of vesicoureteric reflux,
and the patients' recruitment centres, there was no significant
difference between the two treatments on renal scarring. During follow
up, 15 children had recurrence of urinary infection with no significant
difference between the two treatment groups.
CONCLUSIONIn children with acute
pyelonephritis, initial intravenous treatment for 10 days, compared
with three days, does not significantly reduce the development of renal scarring.
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