Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. e174 (doi:10.1542/peds.2008-3122)

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LETTER TO THE EDITOR

Early Antibiotic Treatment of Pyelonephritis in Children Is Still Mandatory: In Reply

Ian K. Hewitt, MBBS, FRACP
Department of Pediatric Nephrology
Princess Margaret Hospital
Perth, Australia

Giovanni Montini, MD
Department of Pediatrics
Azienda Ospedaliera-University of Padua
Padua, Italy

We thank the authors of both letters for raising the possibility that any delay in treatment of symptomatic urinary tract infection (UTI) might significantly increase the risk of acute pyelonephritis on technetium-99m-dimercaptosuccinic acid (DMSA) scan. We undertook further analysis of our original data from the Italian Renal Infection Study (IRIS-1)¹ to determine if this was the case for our patient population.

It is clear from Table 1 that the proportion of children with positive DMSA scan results only starts to increase after 4 days (overall: P < .02; ₅² = 13.8). There is no difference for the first 3 days, with an increase at 4 days becoming significant (P = .002) at 5 days (using logistic regression). This represented 17% of the children presenting with a first febrile UTI. We also included time taken to undertake the DMSA scan after initiation of antibiotic treatment, demonstrating no significant difference that might compromise our results.

View this table: [in this window] [in a new window]   TABLE 1 Risk of Acute Pyelonephritis on DMSA Scan Related to Duration of Fever Before Antibiotic Treatment

 
Thus, we stand by our recommendation of "prompt treatment of febrile UTIs to facilitate rapid recovery from the acute illness" while advising a reduction in the sense of urgency whereby "parents rush to the emergency department or their doctor within hours after the onset of fever, having received the advice that early treatment of relapsing pyelonephritis is essential to avoid renal damage."² We do not advocate waiting for up to 4 days after the onset of fever before seeking treatment.

In addition, the premise of the article that "early treatment of acute pyelonephritis in children fails to reduce renal scarring"² remains unchanged.

REFERENCES

1. Montini G, Toffolo A, Zucchetta P, et al. The IRIS-1 study of antibiotic treatment of pyelonephritis in children: a multicentre randomised controlled non inferiority trial. BMJ. 2007;335 (7616):386[Abstract/Free Full Text]

2. Hewitt IK, Zucchetta P, Rigon L, et al. Early treatment of acute pyelonephritis in children fails to reduce renal scarring: data from the Italian Renal Infection Study Trials. Pediatrics. 2008;122 (3):486 –490[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2009 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Hewitt, I. K. Articles by Montini, G. Search for Related Content PubMed Articles by Hewitt, I. K. Articles by Montini, G. Related Collections Genitourinary Tract Social Bookmarking                         What's this?