BMJ  2004;328:957 (17 April), doi:10.1136/bmj.328.7445.957

Letter

Treatment of acute pyelonephritis in children

Conclusions should have been more cautious

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

EDITOR—The evidence supporting one of Craig and Hodson's major conclusions, that oral and intravenous antibiotics are equally safe and effective for acute pyelonephritis in children, has important caveats.¹

None of the two trials (one published, one ongoing) comparing oral and parenteral antibiotics have found significant differences in the frequency of renal scars after six months to one year of follow up.^{2 3} However, they were not specifically designed to assess whether the two treatments were equivalent. Rather, they aimed to determine whether there were differences between them. Failure to show differences in a randomised controlled trial does not mean that they are equivalent.^{4 5}

The largest study, conducted by Hoberman et al, illustrates the issue.² Renal scarring was found in 11 out of 140 and in 15 out of 132 children assessed six months after treatment with intravenous cefotaxime and oral cefixime, respectively. The absolute rate difference in the frequency . . . [Full text of this article]

School of Medicine, Pontificia Universidad Javeriana. Carrera 7 No 40-62, Bogotá, Colombia jmlozano@javeriana.edu.co

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