ESPN 50th Annual Meeting

ESPN 2017


 
Oral antibiotic treatment for pyelonephritis is safe and effective if there is a formalised contact to the Department of Paediatrics
LINE THOUSIG SEHESTED 1 KONSTANTINOS KAMPERIS 2 LOUISE WINDING 3 CHARLOTTE KJæR BJERRE 4 METTE NELAND 5 SøREN HAGSTRøM 6 LINE KøNIG WILMS 7 MARIE-LOUISE ELKJæR ANDERSEN 8 LINDA KUHNE-QVIST 9 JETTE SKøDE HOFFMANN-PETERSEN 10 HANNE NøRGAARD 11 DINA CORTES 1

1- DEPARTMENT OF PEDIATRICS, COPENHAGEN UNIVERSITY HOSPITAL HVIDOVRE, COPENHAGEN, DENMARK
2- DEPARTMENT OF PEDIATRICS, AARHUS UNIVERSITY HOSPITAL, SKEJBY, AARHUS, DENMARK
3- DEPARTMENT OF PEDIATRICS, LILLEBAELT HOSPITAL KOLDING, DENMARK
4- DEPARTMENT OF PEDIATRICS, COPENHAGEN UNIVERSITY HOSPITAL HILLEROED, HILLEROED, DENMARK
5- DEPARTMENT OF PEDIATRICS, ODENSE UNIVERSITY HOSPITAL, ODENSE, DENMARK
6- DEPARTMENT OF PEDIATRICS, AALBORG HOSPITAL, AALBORG, DENMARK
7- DEPARTMENT OF PEDIATRICS, NAESTVED HOSPITAL, NAESTVED, DENMARK
8- DEPARTMENT OF PEDIATRICS, HOSPITALSENHED MIDT, VIBORG, DENMARK
9- DEPARTMENT OF PEDIATRICS, ESBJERG HOSPITAL, ESBJERG, DENMARK
10- DEPARTMENT OF PEDIATRICS, HERNING HOSPITAL, HERNING, DENMARK
11- DEPARTMENT OF PEDIATRICS, COPENHAGEN UNIVERSITY HOSPITAL RIGSHOSPITALET, COPENHAGEN, DENMARK
 
Introduction:

We investigated the safety and efficacy of out-patient, oral antibiotic treatment of pyelonephritis in Danish children.

Material and methods:

Study population: children > 6 months of age with culture positive pyelonephritis admitted to 11 Paediatric Departments, from October 2014 through December 2015. Septic children and those with known urological anomalies were excluded. The patients were treated 10 days with oral antibiotics (amoxicillin-clavulanate or piv-mecillinam). Our protocol included a nurse telephone consultation with the family on day 2 of treatment, and a clinical re-examination of the patient on day 3. The patients all underwent renal ultrasound and in some centers a renal scintigraphy.

Results:

446 children, 388 (87%) females, median age 27.2 months (range 0.6-16.3 years), 361 (81%) of the population had their first episode of pyelonephritis. Urine was obtained by suprapubic puncture in 52 (26% of those < 2 years), by clean catch urine in 384 (71% had 2 cultures done) and by clean catheterization in 10 girls. Escherichia coli were identified in 410 (92%) patients. The vast majority of patients, 407 (91%) were effectively treated by oral antibiotics, while 39 (9%) were switched to parental antibiotics, causes listed were: lack of clinical improvement (n=18), vomiting (n=7), resistance to antibiotics (n=7) or other problems (n=7). Renal ultrasound was abnormal in 7% (30/433), and renal scintigraphy was abnormal in 13% (36/283). Data analysis comparing “failure of oral antibiotic treatment” with those who succeeded revealed no significant predictor of treatment failure with oral antibiotics: age (p=0.826), C-reactive protein (p=0.064), frequency of girls (p=0.814), Escherichia coli (p= 0.776), first pyelonephritis (p=0.929), abnormal ultrasound or abnormal scintigraphy (p=0.599, p=0.918), respectively.

Conclusions:

Treatment of pyelonephritis with oral piv-mecillinam or amoxicillin-clavulanate at home is safe and effective, but formalized contact to the Paediatric Departments is required as 9% of patients need a shift to intravenous antibiotic treatment.