BMJ  2004;328:179-180 (24 January), doi:10.1136/bmj.328.7433.179

Editorial

Treatment of acute pyelonephritis in children

Evidence favours the oral route and a short course of appropriate antibiotics

The first 150 words of the full text of this article appear below.

A 9 month old girl presents with high fever, vomiting, lethargy, and bacteriologically confirmed urinary tract infection. The diagnosis is clear—acute pyelonephritis. This is a common problem and the cause of about 5% of febrile episodes in children.¹ But how should she be treated? Which antibiotics should be given and by which route? For how long should antibiotics be given? This article summarises what we know about treatment of acute pyelonephritis from randomised trials and what we think we know about treatment, based on clinical experience.

Acute pyelonephritis comprises urinary tract infection with systemic features including fever, vomiting, abdominal or loin pain, and lethargy. Fever is the most useful symptom clinically. Compared with the reference standard for pyelonephritis—technetium-99m dimercaptosuccinic acid scanning—fever is very sensitive but has only moderate specificity. In few afebrile children—except very young infants—the renal parenchyma is affected. Conversely in about 50% of children with clinical pyelonephritis the . . . [Full text of this article]

(jonc@health.usyd.edu.au), Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW 2145 Australia

department of nephrology, Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW 2145 Australia

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Rapid Responses:

Read all Rapid Responses

Are oral and intravenous antibiotics for children with pyelonepritis really equivalent? Caution needed

Juan M. Lozano
bmj.com, 30 Jan 2004 [Full text]