Effective Duration of Antimicrobial Therapy for the Treatment of Acute Lobar Nephronia

Abstract

OBJECTIVE. Effective treatment of acute lobar nephronia (ALN) can prevent its progression to renal abscess. The goal of this prospective study was to compare the treatment efficacy for pediatric patients who had ALN with a 3-vs 2-week intravenous plus oral antimicrobial-therapy regimen. METHODS.Patients who were suspected of having an upper urinary tract infection underwent a systematic scheme of ultrasonographic and computed tomographic (CT) evaluation for ALN diagnosis. Patients with positive CT findings were enrolled and randomly allocated with serial entry for either a total 2-week or a 3-week antibiotic treatment regimen. Antibiotics were changed from an intravenous form to an oral form 2 to 3 days after defervescence of fever. Follow-up clinical evaluations and urine-culture analyses were performed 3 to 7 days after cessation of antibiotic treatment. Patients with persistent infection or relapse were considered as treatment failures.RESULTS. A total of 80 patients with ALN were enrolled. Forty-one patients were treated with a 2-week antimicrobial protocol, and the other 39 patients were treated with a 3-week course. Seven treatment failures, 1 persistent infection, and 6 infection relapses were identified, all of which were in the 2-week treatment group. Prolonged fever before admission and positive Escherichia coli growth (Ͼ10 5 colony-forming units per mL) in urine culture were noted as risk factors for treatment failure. All treatment failures were managed successfully with an additional 10-day antibiotic course.CONCLUSION. A total of 3 weeks of intravenous and oral antibiotic therapy tailored to the pathogen noted in cultures should be the treatment of choice for pediatric patients with ALN.www.pediatrics.org/cgi

Studies on Clinical Characteristics, Urovirulence Factor and Host Susceptibility Gene in Pediatric Acute Lobar Nephronia

“…ALN was shown to be the only independent risk factor for renal scarring (P < 0.001; Table 4.3) The duration and route of administration of antibiotics have been shown not to influence the risk for renal scarring in patients with APN (Hoberman and Wald et al 1999;Bouissou et al 2008). Our previous prospective study (Cheng et al 2006) suggested that 3 weeks of antibiotic therapy was the treatment of choice for all radiographically documented ALN patients; a longer duration of antibiotic use resulted in the successful treatment for ALN but did not reduce the risk for renal scarring. In most reported studies, including ours, the Table 4.3.…”

“…Although it has been suggested that the treatment duration for ALN needs to be at least the same as that for uncomplicated APN, recommendations for the duration of antibiotic treatment still remains somewhat inconclusive, and to the best of our knowledge, for neither condition, has a rigorous therapeutic efficacy comparison of relevant medication been performed (Rathore et al, 1991). We have performed a study sought to determine the appropriate duration of effective antibiotic therapy for the management of pediatric ALN patients (Cheng et al, 2006). Patients who first presented as febrile UTI and who later were diagnosed with positive CT findings of ALN were entered into this study for receiving either a two-week or a threeweek intravenous and oral antibiotic therapeutic program.…”

“…For patients who underwent VCUG, no difference as regards the presence of VUR in either frequency or severity was found between the two treatment groups. (Cheng et al, 2006).…”

“…Table 3.2. Comparison of demographic data, clinical characteristics and laboratory results between the ALN patients with treatment failure and those with treatment success for the two-week antibiotic therapy protocol (Cheng et al, 2006).…”

“…Our early studies showed that E. coli was the most common pathogen cultured from the patients with ALN (Cheng et al 2004(Cheng et al , 2006, having a higher percentage of pathogens than the first-time UTIs (Hoberman and Wald 1999). This finding has led us to this investigation of the pathogenetic association of the bacterial virulence factors as well as the genotypes of the E. coli isolates in pediatric ALN.…”