Bloomfield P, Hodson E M, Craig J C
Cochrane Database Syst Rev. 2003(3):CD003772. doi: 10.1002/14651858.CD003772.
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.
To determine the benefits and harms of different antibiotic regimens for the treatment of acute pyelonephritis in children.
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.
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.
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).
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.
尿路感染（UTI）是婴儿最常见的细菌感染之一。UTI最严重的形式是急性肾盂肾炎，可导致严重的急性发病，并可能造成永久性肾损伤。已发布的指南建议急性肾盂肾炎最初采用静脉（IV）治疗，随后口服治疗7 - 14天，不过对于IV治疗或口服治疗的持续时间尚无共识。
确定不同抗生素治疗方案对儿童急性肾盂肾炎治疗的益处和危害。
我们检索了Cochrane对照试验注册库（Cochrane图书馆2002年第3期）、MEDLINE（1966年 - 2002年9月）、EMBASE（1988年 - 2002年9月），以及文章参考文献列表和会议论文摘要，无语言限制。
选取了比较0 - 18岁确诊UTI和急性肾盂肾炎儿童不同抗生素药物、给药途径、频率或治疗持续时间的随机和半随机对照试验。
两名评价员独立评估试验质量并提取数据。采用随机效应模型进行统计分析，结果以二分类结局的相对危险度（RR）或连续数据的加权均数差（WMD）表示，并给出95%置信区间（CI）。
16项涉及1872名儿童的试验符合纳入标准。口服头孢克肟治疗（14天）与IV治疗（3天）后口服治疗（10天）相比，6个月时持续性肾损伤（一项试验，306名婴儿：RR 1.45，95% CI 0.69至3.
