-
BMJ Clinical Evidence Feb 2008Pyelonephritis is usually caused by ascent of bacteria, most often Escherichia coli, from the bladder, and is more likely in people with structural or functional urinary... (Review)
Review
INTRODUCTION
Pyelonephritis is usually caused by ascent of bacteria, most often Escherichia coli, from the bladder, and is more likely in people with structural or functional urinary tract abnormalities. The prognosis is good if pyelonephritis is treated appropriately, but complications include renal abscess, renal impairment, and septic shock.
METHODS AND OUTCOMES
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of: oral antibiotic treatments for acute pyelonephritis in women with uncomplicated infection; antibiotic treatments in women admitted to hospital with complicated infection; inpatient versus outpatient management in women with uncomplicated infection; analgesia in uncomplicated acute pyelonephritis? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS
We found 5 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS
In this systematic review we present information relating to the effectiveness and safety of the following interventions: analgesics, inpatient management, intravenous antibiotics, non-opioids, non-steroidal anti-inflammatory drugs, oral antibiotics, outpatient management, urinary analgesics.
Topics: Acute Disease; Administration, Oral; Anti-Bacterial Agents; Escherichia coli; Female; Humans; Incidence; Pyelonephritis; Urinary Tract Infections
PubMed: 19450332
DOI: No ID Found -
The Cochrane Database of Systematic... Oct 2007Urinary tract infection (UTI) is one of the most common bacterial infection in infants. The most severe form of UTI is acute pyelonephritis, which results in significant... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Urinary tract infection (UTI) is one of the most common bacterial infection in infants. The most severe form of UTI is acute pyelonephritis, which results in significant acute morbidity and may cause permanent renal damage. Published guidelines recommend treatment of acute pyelonephritis initially with intravenous (IV) therapy followed by oral therapy for seven to 14 days though there is no consensus on the duration of either IV or oral therapy.
OBJECTIVES
To determine the benefits and harms of different antibiotic regimens for the treatment of acute pyelonephritis in children.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, reference lists of articles and conference proceedings without language restriction. Date of most recent search: December 2006.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials comparing different antibiotic agents, routes, frequencies or durations of therapy in children aged 0 to 18 years with proven UTI and acute pyelonephritis were selected.
DATA COLLECTION AND ANALYSIS
Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or mean difference (WMD) for continuous data with 95% confidence intervals (CI).
MAIN RESULTS
Twenty three studies (3295 children) were eligible for inclusion. No significant differences were found in persistent renal damage at 6 months (2 studies, 424 children: RR 0.87, 95% CI 0.35 to 2.16) or in duration of fever (2 studies, 693 children: WMD 1.54, 95% CI -1.67 to 4.76) between oral antibiotic therapy (10 to 14 days) and IV therapy (3 days) followed by oral therapy (10 days). Similarly no significant differences in persistent renal damage (3 studies, 341 children: RR 1.13, 95% CI 0.86 to 1.49) were found between IV therapy (3 to 4 days) followed by oral therapy and IV therapy for 7 to 14 days. No significant differences in efficacy were found between daily and thrice daily administration of aminoglycosides (1 study, 179 children, persistent symptoms at 3 days: RR 1.98, 95% CI 0.37 to 10.53).
AUTHORS' CONCLUSIONS
These results suggest that children with acute pyelonephritis can be treated effectively with oral antibiotics (cefixime, ceftibuten and amoxycillin/clavulanic acid) or with short courses (2 to 4 days) of IV therapy followed by oral therapy. If IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective. Studies are required to determine the optimal total duration of therapy.
Topics: Acute Disease; Administration, Oral; Adolescent; Anti-Bacterial Agents; Child; Humans; Infant; Injections, Intravenous; Pyelonephritis; Randomized Controlled Trials as Topic
PubMed: 17943796
DOI: 10.1002/14651858.CD003772.pub3 -
The Cochrane Database of Systematic... Apr 2007Asymptomatic bacteriuria occurs in 2% to 10% of pregnancies and, if not treated, up to 30% of mothers will develop acute pyelonephritis. Asymptomatic bacteriuria has... (Review)
Review
BACKGROUND
Asymptomatic bacteriuria occurs in 2% to 10% of pregnancies and, if not treated, up to 30% of mothers will develop acute pyelonephritis. Asymptomatic bacteriuria has been associated with low birthweight and preterm delivery.
OBJECTIVES
To assess the effect of antibiotic treatment for asymptomatic bacteriuria on persistent bacteriuria during pregnancy, the development of pyelonephritis and the risk of low birthweight and preterm delivery.
SEARCH STRATEGY
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2007).
SELECTION CRITERIA
Randomized trials comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening.
DATA COLLECTION AND ANALYSIS
We assessed trial quality.
MAIN RESULTS
Fourteen studies were included. Overall the study quality was poor. Antibiotic treatment compared to placebo or no treatment was effective in clearing asymptomatic bacteriuria (risk ratio (RR) 0.25, 95% confidence interval (CI) 0.14 to 0.48). The incidence of pyelonephritis was reduced (RR 0.23, 95% CI 0.13 to 0.41). Antibiotic treatment was also associated with a reduction in the incidence of low birthweight babies (RR 0.66, 95% CI 0.49 to 0.89) but a difference in preterm delivery was not seen.
AUTHORS' CONCLUSIONS
Antibiotic treatment is effective in reducing the risk of pyelonephritis in pregnancy. A reduction in low birthweight is consistent with current theories about the role of infection in adverse pregnancy outcomes, but this association should be interpreted with caution given the poor quality of the included studies.
Topics: Anti-Bacterial Agents; Bacteriuria; Confidence Intervals; Female; Humans; Odds Ratio; Pregnancy; Pregnancy Complications, Infectious; Pyelonephritis; Randomized Controlled Trials as Topic
PubMed: 17443502
DOI: 10.1002/14651858.CD000490.pub2 -
The American Journal of Medicine Nov 2005We performed a meta-analysis to ascertain the efficacy and safety of the currently practiced 3-day antibiotic therapy for cystitis versus prolonged therapy (5 days or... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
We performed a meta-analysis to ascertain the efficacy and safety of the currently practiced 3-day antibiotic therapy for cystitis versus prolonged therapy (5 days or longer) to relieve symptoms and to achieve bacteriological cure.
METHODS
The Cochrane Library, the Cochrane Renal Group's Register of trials, EMBASE and MEDLINE were searched to identify all randomized controlled trials comparing 3-day oral antibiotic therapy with prolonged therapy (5 days and longer) for uncomplicated cystitis in adult non-pregnant women. Two reviewers independently applied selection criteria, performed quality assessment, and extracted data. Relative risks (RR) with their 95% confidence intervals (CI) were estimated; a fixed effect model was used. An intention-to-treat analysis was performed whenever possible.
RESULTS
Thirty-two trials and 9605 patients met inclusion criteria. For symptomatic failure rates no difference between 3-day and prolonged antibiotic regimens was found at short term (RR 1.16, 95% CI: 0.96-1.41) and long-term follow-up (RR 1.17, 95% CI: 0.99-1.38). Three-day treatment was less effective than prolonged therapy in preventing bacteriological failure, relative risk 1.37 (95% CI: 1.07-1.74) for short-term follow-up, and 1.47 (95% CI: 1.22-1.77) for long-term follow-up. Adverse effects were more common in the prolonged therapy group (RR 0.83, 95% CI: 0.79-0.91). The results were consistent for subgroup and sensitivity analyses.
CONCLUSION
Antibiotic therapy for 3 days is similar to prolonged therapy in achieving symptomatic cure for cystitis, while the prolonged treatment is more effective in obtaining bacteriological cure.
Topics: Administration, Oral; Adolescent; Adult; Aged; Ambulatory Care; Anti-Bacterial Agents; Bacteriuria; Cystitis; Drug Administration Schedule; Drug Resistance; Evidence-Based Medicine; Female; Follow-Up Studies; Gram-Negative Bacterial Infections; Humans; Middle Aged; Pyelonephritis; Randomized Controlled Trials as Topic; Recurrence; Risk; Selection Bias; Staphylococcal Infections; Treatment Outcome
PubMed: 16271900
DOI: 10.1016/j.amjmed.2005.02.005 -
The Cochrane Database of Systematic... Jan 2005Urinary tract infection (UTI) is one of the most common bacterial infection in infants. The most severe form of UTI is acute pyelonephritis, which results in significant... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Urinary tract infection (UTI) is one of the most common bacterial infection in infants. The most severe form of UTI is acute pyelonephritis, which results in significant acute morbidity and may cause permanent renal damage. Published guidelines recommend treatment of acute pyelonephritis initially with intravenous (IV) therapy followed by oral therapy for seven to 14 days though there is no consensus on the duration of either IV or oral therapy.
OBJECTIVES
To determine the benefits and harms of different antibiotic regimens for the treatment of acute pyelonephritis in children.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, reference lists of articles and abstracts from conference proceedings without language restriction. Date of most recent search: June 2004.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials comparing different antibiotic agents, routes, frequencies or durations of therapy in children aged 0 to 18 years with proven UTI and acute pyelonephritis were selected.
DATA COLLECTION AND ANALYSIS
Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or weight mean difference (WMD) for continuous data with 95% confidence intervals (CI).
MAIN RESULTS
Eighteen trials (2612 children) were eligible for inclusion. No significant differences were found in persistent renal damage at six months (one trial, 306 infants: RR 1.45, 95% CI 0.69 to 3.03) or in duration of fever (WMD 0.80, 95% CI -4.41 to - 6.01) between oral cefixime therapy (14 days) and IV therapy (three days) followed by oral therapy (10 days). Similarly no significant differences in persistent renal damage (three trials, 315 children: RR 0.99, 95% CI 0.72 to 1.37) were found between IV therapy (3-4 days) followed by oral therapy and IV therapy for 7-14 days. In addition no significant differences in efficacy were found between daily and thrice daily administration of aminoglycosides (one trial, 179 children, persistent symptoms at three days: RR 1.98, 95% CI 0.37 to 10.53).
AUTHORS' CONCLUSIONS
These results suggest that children with acute pyelonephritis can be treated effectively with oral cefixime or with short courses (2-4 days) of IV therapy followed by oral therapy. If IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective. Trials are required to determine the optimal total duration of therapy and if other oral antibiotics can be used in the initial treatment of acute pyelonephritis.
Topics: Acute Disease; Administration, Oral; Adolescent; Anti-Bacterial Agents; Child; Humans; Infant; Injections, Intravenous; Pyelonephritis; Randomized Controlled Trials as Topic
PubMed: 15674914
DOI: 10.1002/14651858.CD003772.pub2 -
The Cochrane Database of Systematic... 2003Urinary tract infection (UTI) is one of the most common bacterial infection in infants. The most severe form of UTI is acute pyelonephritis, which results in significant... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Urinary tract infection (UTI) is one of the most common bacterial infection in infants. The most severe form of UTI is acute pyelonephritis, which results in significant acute morbidity and may cause permanent renal damage. Published guidelines recommend treatment of acute pyelonephritis initially with intravenous (IV) therapy followed by oral therapy for 7-14 days though there is no consensus on the duration of either IV or oral therapy.
OBJECTIVES
To determine the benefits and harms of different antibiotic regimens for the treatment of acute pyelonephritis in children.
SEARCH STRATEGY
We searched the Cochrane Register of Controlled Trials (Cochrane Library Issue 3, 2002), MEDLINE (1966 - September 2002), EMBASE (1988 -September 2002), reference lists of articles and abstracts from conference proceedings without language restriction.
SELECTION CRITERIA
Randomised and quasi-randomised controlled trials comparing different antibiotic agents, routes, frequencies or durations of therapy in children aged 0-18 years with proven UTI and acute pyelonephritis were selected.
DATA COLLECTION AND ANALYSIS
Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) for dichotomous outcomes or weight mean difference (WMD) for continuous data with 95% confidence intervals (CI).
MAIN RESULTS
Sixteen trials involving 1872 children were eligible for inclusion. No significant differences were found in persistent renal damage at six months (one trial, 306 infants: RR 1.45, 95% CI 0.69 to 3.03) or in duration of fever (WMD 0.80, 95% CI -4.41 to - 6.01) between oral cefixime therapy (14 days) and IV therapy (three days) followed by oral therapy (10 days). Similarly no significant differences in persistent renal damage (three trials, 315 children: RR 0.99, 95% CI 0.72 to 1.37) were found between IV therapy (3-4 days) followed by oral therapy and IV therapy for 7-14 days. In addition no significant differences in efficacy were found between daily and thrice daily administration of aminoglycosides (one trial, 179 children, persistent symptoms at three days: RR 1.98, 95% CI 0.37 to 10.53).
REVIEWER'S CONCLUSIONS
These results suggest that children with acute pyelonephritis can be treated effectively with oral cefixime or with short courses (2-4 days) of IV therapy followed by oral therapy. If IV therapy is chosen, single daily dosing with aminoglycosides is safe and effective. Trials are required to determine the optimal total duration of therapy and if other oral antibiotics can be used in the initial treatment of acute pyelonephritis.
Topics: Adolescent; Anti-Bacterial Agents; Child; Humans; Infant; Pyelonephritis; Randomized Controlled Trials as Topic
PubMed: 12917987
DOI: 10.1002/14651858.CD003772 -
The Cochrane Database of Systematic... 2001Up to 30% of mothers develop acute pyelonephritis if asymptomatic bacteriuria is untreated. Asymptomatic bacteriuria may have a role in preterm birth or it may be a... (Review)
Review
BACKGROUND
Up to 30% of mothers develop acute pyelonephritis if asymptomatic bacteriuria is untreated. Asymptomatic bacteriuria may have a role in preterm birth or it may be a marker for low socioeconomic status which is associated with low birth weight.
OBJECTIVES
The objective of this review was to assess the effect of antibiotic treatment for asymptomatic bacteriuria on persistent bacteriuria during pregnancy, the risk of preterm delivery, and the development of pyelonephritis.
SEARCH STRATEGY
I searched the Cochrane Pregnancy and Childbirth Group trials register. Date of last search: December 2000.
SELECTION CRITERIA
Randomised trials comparing antibiotic treatment with placebo or no treatment in pregnant women with asymptomatic bacteriuria found on antenatal screening.
DATA COLLECTION AND ANALYSIS
Trial quality was assessed.
MAIN RESULTS
Fourteen studies were included. Overall the study quality was not strong. Antibiotic treatment compared to placebo or no treatment was effective in clearing asymptomatic bacteriuria (odds ratio 0.07, 95% confidence interval 0.05 to 0.10). The incidence of pyelonephritis was reduced (odds ratio 0.24, 95% confidence interval 0.19 to 0.32). Antibiotic treatment was also associated with a reduction in the incidence of preterm delivery or low birth weight babies (odds ratio 0.60, 95% confidence interval 0.45 to 0.80).
REVIEWER'S CONCLUSIONS
Antibiotic treatment is effective in reducing the risk of pyelonephritis in pregnancy. An apparent reduction in preterm delivery is consistent with current theories about the role of infection in preterm birth, but this association should be interpreted with caution.
Topics: Anti-Bacterial Agents; Bacteriuria; Confidence Intervals; Female; Humans; Odds Ratio; Pregnancy; Pregnancy Complications, Infectious; Pyelonephritis; Randomized Controlled Trials as Topic
PubMed: 11405965
DOI: 10.1002/14651858.CD000490