Farmacoriflessioni
La terapia antibiotica della pielonefrite acuta
ANTIBIOTIC TREATMENT OF ACUTE PYELONEPHRITIS
FEDERICO MARCHETTI1, MARCO PENNESI1, PAOLO PECILE2, SERENA ELLERO2, CRISTINA BRONDELLO3, LEOPOLDO PERATONER4
1Clinica Pediatrica, IRCCS “Burlo Garofolo”, Universitŕ di Trieste
2Clinica Pediatrica, Universitŕ di Udine
3Dipartimento di Scienze Pediatriche e dell’Adolescenza, Ospedale Infantile “Regina Margherita”, Torino
4UO di Pediatria, Azienda Ospedaliera “S. Maria degli Angeli”, Pordenone
Maggio 2004 - pagg. 316 -319
Abstract
This is a review article about antibiotic treatment of acute pyelonephritis (APN). Diagnosis of
APN requires high fever and urine test positive for leukocytes and bacteria. The major decisions
about treatment that are to be made concern the use of antibiotics. Infants aged 1
month or less with APN require intravenous (IV) antibiotics because of the high prevalence of
concomitant bacteraemia (about 10%). Ceftriaxone or aminoglycosides are the chosen medicines.
After the first month of life, oral antibiotics are as safe and effective as IV antibiotics
in children with a clinical diagnosis of APN. There is no evidence to support the practice of
giving a single dose of parenteral antibiotics in addition to a standard course of orally administered
antibiotics. IV treatment should be preserved for children who are seriously ill, or
who fail oral treatment because of persistent vomiting. Since Escherichia coli is the most
common pathogen (about 90% of cases), empirical treatment with a β-lactam oral antibiotic
(cephalosporines or amoxicillin-clavulanic acid) is indicated. The choice of specific antibiotics
should be based on data about local uropathogens. Trials are required to determine the
optimal total duration of therapy.
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
1. Hoberman A, Chao HP, Keller DM, Hockey
R, Davis HW, Ellis D. Prevalence of urinary
tract infection in febbrile infants. J Pediatr
1993;123:17-23.
2. Leibovici L. Monotherapy versus beta-lactam- aminoglicoside combination treatment for Gram-negative bacteremia: a prospective, observational study. Antimicrob Agents Chemother 1997;41(5):1127-33.
3. James J. Ceftriaxone-clinical experience in the treatment of neonates. J Infect 1985; 11(1):25-33.
4. Craig JC, Hodson EM. Treatment of acute pyelonephritis in children. BMJ 2004;328:179- 80.
5. Bloomfield P, Hodson EM, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Sys Rev 2003;(3): CD003772.
6. Hoberman A, Wald ER, Hickey R, Baskin M, Charron M, Majd M., et al. Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics 1999;104:79-86.
7. Montini G, Murer L, Gobber D, Comacchio S, Toffolo A, Dall’Amico R., et al. on behalf of the IRIS Study Group. Oral vs initial intravenous antibiotic treatment of urinary tract infections in children: a multicentre trial. Nephrol Dial Transpl 2003;18 (suppl 4):816a.
8. Baker PC, Nelson DS, Schunk JE. The addition of ceftriaxone to oral therapy does not improve outcome in febrile children with urinary tract infections. Arch Pediatr Adolesc Med 2001;155:135-9.
9. American Academy of Pediatrics. Committee on Quality improvement. Subcommittee on Urinary tract infection. Practice parameter: the diagnosis, treatment and evaluation of the initial urinary tract infections in febrile infants and young children. Pediatrics 1999;103(4): 843-852.
10. Prais D, Straussberg R, Avitzur Y, Nussinovitch M, Harel L, Amir J. Bacterial susceptibility to oral antibiotics in community acquired urinary tract infection. Arch Dis Child 2003;88:215-18.
11. Ladhani S, Gransden W. Increasing antibiotic resistence among urinary tract isolates. Arch Dis Child 2003;88:444-5.
12. Brondello C, Bretto R, Zambelli MC, Costamagna M, Laccisaglia A, Gianino P. Pielonefrite acuta nel lattante: eziologia e sensibilitŕ agli antibiotici. Medico e Bambino 2004, Maggio, Pagine elettroniche- www.medicoebambino. com.
13. Neu HC. Ceftibuten: minimal inhibitory concentrations, postantibiotic effect and betalactamase stability-a rationale for dosing programs. Pediatr Infect Dis J1995;14(7 Suppl): S88-92.
14. Jones RN. In vitro antibacterial activity of oral cephalosporins. A selective and comparative review. Clin Drug Invest 1995;9 (suppl 3): 22-30.
15. Vigano A, Principi N, Brivio L, Tommasi P, Stasi P, Dalla Villa A. Comparison of 5 milligrams of netilmicin per kilogram of body weight once daily versus 2 milligrams per kilogram thrice daily for treatment of Gram-negative pyelonephritis in children. Antimicrob Agents Chemother 1992;36:1499-503.
16. Carapetis J, Jaquiery A, Buttery J, Starr M, Cranswick N, Kohn S, et al. Randomized, controlled trial comparing once daily and three times daily gentamicin in children with urinary tract infections. Pediatr Infect Dis J 2001; 20:240-6.
17. Cong CY, Tan AS, Ng W, Tan-Kendrick A, Balakrishnan A, Chao SM. Treatment of urinary tract infection with gentamicin once or three times daily. Acta Paediatr 2003;92:291- 6.
18. Hatala R, Dinh T, Cook DJ. Once-daily aminoglycoside dosing in immunocompetent adults: a meta-analysis. Ann Intern Med 1996; 124:717-25.
19. Michael M, Hodson EM, Craig JC, Martin S, Moyer VA. Short compared with standard duration of antibiotic treatment for urinary tract infection: a systematic review of randomised controlled trials. Arch Dis Child 2002; 87:118-23.
20. Peratoner L, Coprivez A, Panei P, a nome del Gruppo di Studio della Pediatria Ospedaliera. La pielonefrite acuta. Medico e Bambino 1999;4:241-5.
21. Marchetti F, La Gamba G, Peratoner L, Coprivez A, Pennesi A, Boschi G, D’Andrea N, a nome del Gruppo di Studio della Pediatria Ospedaliera. Le domande aperte sulla gestione della broncopolmonite e pielonefrite acuta. Quaderni acp 1999; vol VI, 5: 24-30.
2. Leibovici L. Monotherapy versus beta-lactam- aminoglicoside combination treatment for Gram-negative bacteremia: a prospective, observational study. Antimicrob Agents Chemother 1997;41(5):1127-33.
3. James J. Ceftriaxone-clinical experience in the treatment of neonates. J Infect 1985; 11(1):25-33.
4. Craig JC, Hodson EM. Treatment of acute pyelonephritis in children. BMJ 2004;328:179- 80.
5. Bloomfield P, Hodson EM, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Sys Rev 2003;(3): CD003772.
6. Hoberman A, Wald ER, Hickey R, Baskin M, Charron M, Majd M., et al. Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics 1999;104:79-86.
7. Montini G, Murer L, Gobber D, Comacchio S, Toffolo A, Dall’Amico R., et al. on behalf of the IRIS Study Group. Oral vs initial intravenous antibiotic treatment of urinary tract infections in children: a multicentre trial. Nephrol Dial Transpl 2003;18 (suppl 4):816a.
8. Baker PC, Nelson DS, Schunk JE. The addition of ceftriaxone to oral therapy does not improve outcome in febrile children with urinary tract infections. Arch Pediatr Adolesc Med 2001;155:135-9.
9. American Academy of Pediatrics. Committee on Quality improvement. Subcommittee on Urinary tract infection. Practice parameter: the diagnosis, treatment and evaluation of the initial urinary tract infections in febrile infants and young children. Pediatrics 1999;103(4): 843-852.
10. Prais D, Straussberg R, Avitzur Y, Nussinovitch M, Harel L, Amir J. Bacterial susceptibility to oral antibiotics in community acquired urinary tract infection. Arch Dis Child 2003;88:215-18.
11. Ladhani S, Gransden W. Increasing antibiotic resistence among urinary tract isolates. Arch Dis Child 2003;88:444-5.
12. Brondello C, Bretto R, Zambelli MC, Costamagna M, Laccisaglia A, Gianino P. Pielonefrite acuta nel lattante: eziologia e sensibilitŕ agli antibiotici. Medico e Bambino 2004, Maggio, Pagine elettroniche- www.medicoebambino. com.
13. Neu HC. Ceftibuten: minimal inhibitory concentrations, postantibiotic effect and betalactamase stability-a rationale for dosing programs. Pediatr Infect Dis J1995;14(7 Suppl): S88-92.
14. Jones RN. In vitro antibacterial activity of oral cephalosporins. A selective and comparative review. Clin Drug Invest 1995;9 (suppl 3): 22-30.
15. Vigano A, Principi N, Brivio L, Tommasi P, Stasi P, Dalla Villa A. Comparison of 5 milligrams of netilmicin per kilogram of body weight once daily versus 2 milligrams per kilogram thrice daily for treatment of Gram-negative pyelonephritis in children. Antimicrob Agents Chemother 1992;36:1499-503.
16. Carapetis J, Jaquiery A, Buttery J, Starr M, Cranswick N, Kohn S, et al. Randomized, controlled trial comparing once daily and three times daily gentamicin in children with urinary tract infections. Pediatr Infect Dis J 2001; 20:240-6.
17. Cong CY, Tan AS, Ng W, Tan-Kendrick A, Balakrishnan A, Chao SM. Treatment of urinary tract infection with gentamicin once or three times daily. Acta Paediatr 2003;92:291- 6.
18. Hatala R, Dinh T, Cook DJ. Once-daily aminoglycoside dosing in immunocompetent adults: a meta-analysis. Ann Intern Med 1996; 124:717-25.
19. Michael M, Hodson EM, Craig JC, Martin S, Moyer VA. Short compared with standard duration of antibiotic treatment for urinary tract infection: a systematic review of randomised controlled trials. Arch Dis Child 2002; 87:118-23.
20. Peratoner L, Coprivez A, Panei P, a nome del Gruppo di Studio della Pediatria Ospedaliera. La pielonefrite acuta. Medico e Bambino 1999;4:241-5.
21. Marchetti F, La Gamba G, Peratoner L, Coprivez A, Pennesi A, Boschi G, D’Andrea N, a nome del Gruppo di Studio della Pediatria Ospedaliera. Le domande aperte sulla gestione della broncopolmonite e pielonefrite acuta. Quaderni acp 1999; vol VI, 5: 24-30.