Transition to oral antibiotic therapy for pyelonephritis in children under 60 days of age: An observational retrospective cohort study

Abstract

Objectives: To describe the use of antibiotics and assess if an early transition from intravenous to oral antibiotic therapy is generally safe in infants less than 60 days of age with a diagnosis of pyelonephritis. Methods: This retrospective observational cohort study included hospitalized infants less than 60 days with a diagnosis of pyelonephritis based on fever or systemic symptoms and a positive urine culture between January 1, 2015 and July 30, 2017 at a Canadian paediatric tertiary care centre. Results: A total of 108 infants were included. Forty-eight of them were under 1 month of age. The median intravenous (IV) antibiotic therapy duration was 3.5 days, with a longer duration of 4 days in infants less than 1 month of age. The total antibiotic therapy was almost equally divided between a shorter (10 days) and longer (14 days) duration. The recurrence of pyelonephritis within the 2 months following the initial urinary infection was 9 % in the group with IV antibiotic therapy duration of <4 days, compared to 11% in the group treated ≥4 days IV (P-value 0.75). There was a recurrence of pyelonephritis of 10.2% in the group treated for 10 days, compared to 11.5% of recurrence in the group treated for 14 days (P-value 1.0). Conclusions: Our study provides limited retrospective data regarding the management of pyelonephritis in infants less than 60 days of age. Prospective research is needed to confirm those findings.