Published online December 1, 2005
PEDIATRICS Vol. 117 No. 1 January 2006, pp. e84-e89 (doi:10.1542/peds.2005-0917)
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ARTICLE

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

Chi-Hui Cheng, MDa, Yong-Kwei Tsau, MDb and Tzou-Yien Lin, MDc

a Divisions of Pediatric Nephrology
c Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Taoyuan, Taiwan
b Division of Pediatric Nephrology, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan

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 (>105 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.

Key Words: acute focal bacterial nephritis • antibiotic treatment • treatment failure • efficacy evaluation • CT scan

Abbreviations: UTI—urinary tract infection • ALN—acute lobar nephronia • APN—acute pyelonephritis • CT—computed tomography • VCUG—voiding cystourethrography • cfu—colony-forming unit(s) • VUR—vesicoureteral reflux

Accepted Jul 7, 2005.


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