Vouloumanou Evridiki K, Rafailidis Petros I, Kazantzi Maria S, Athanasiou Stavros, Falagas Matthew E
Alfa Institute of Biomedical Sciences, Athens, Greece.
Curr Med Res Opin. 2008 Dec;24(12):3423-34. doi: 10.1185/03007990802550679.
Acute pyelonephritis is a common infection with significant morbidity and mortality, particularly in pediatric populations. Early-switch strategies (from intravenous to oral treatment) may be an acceptable or even preferred option in the treatment of patients with acute pyelonephritis in terms of effectiveness and safety and can also reduce the economical burden associated with pyelonephritis.
We sought to evaluate the effectiveness and safety of early-switch strategies in hospitalized patients with acute uncomplicated pyelonephritis.
We searched in PubMed, Cochrane Central Register of Controlled Trials, and Scopus to identify randomized controlled trials (RCTs) that compared intravenous antibiotic regimens to regimens including an early switch to oral (after initial intravenous) treatment.
Eight RCTs (6 in children) were eligible for inclusion. In 5 RCTs the intravenous antibiotic treatment arms were not switched to oral treatment until the end of the study while in the remaining 3 RCTs the intravenous arms were switched late to oral treatment (after 5-10 days). Data regarding the incidence of renal scars, microbiological eradication, clinical cure, reinfection, persistence of acute pyelonephritis, and adverse events were provided in 4 (all pediatric trials), 6 (4 pediatric), 4 (2 pediatric), 5 (3 pediatric), 3 (1 pediatric), and 5 RCTs (3 pediatric), respectively. There were no differences regarding the above outcomes between the two compared treatment regimens in either pediatric or adult populations.
Early switch to oral antibiotic strategies seem to be as effective and safe as intravenous regimens for the treatment of hospitalized patients with acute pyelonephritis. These findings suggest that there is probably a potential to decrease the duration of intravenous treatment by 4-11 days in hospitalized patients with acute pyelonephritis without compromising their outcomes.
急性肾盂肾炎是一种常见感染，具有较高的发病率和死亡率，在儿科人群中尤为如此。就有效性和安全性而言，早期转换策略（从静脉治疗转换为口服治疗）可能是治疗急性肾盂肾炎患者的可接受甚至更优选择，还可减轻与肾盂肾炎相关的经济负担。
我们旨在评估早期转换策略在住院治疗的急性非复杂性肾盂肾炎患者中的有效性和安全性。
我们检索了PubMed、Cochrane对照试验中心注册库和Scopus，以确定将静脉抗生素治疗方案与包括早期转换为口服（初始静脉治疗后）治疗的方案进行比较的随机对照试验（RCT）。
八项RCT（六项针对儿童）符合纳入标准。在五项RCT中，静脉抗生素治疗组直到研究结束才转换为口服治疗，而在其余三项RCT中，静脉治疗组较晚转换为口服治疗（5 - 10天后）。分别在四项（均为儿科试验）、六项（四项儿科）、四项（两项儿科）、五项（三项儿科）、三项（一项儿科）和五项RCT（三项儿科）中提供了关于肾瘢痕发生率、微生物清除、临床治愈、再感染、急性肾盂肾炎持续存在和不良事件的数据。在儿科或成人人群中，两种比较的治疗方案在上述结局方面没有差异。
对于住院治疗的急性肾盂肾炎患者，早期转换为口服抗生素策略似乎与静脉治疗方案一样有效和安全。这些发现表明，在不影响住院急性肾盂肾炎患者治疗效果的情况下，可能有潜力将静脉治疗时间缩短4 - 11天。
