Children with acute pyelonephritis need medical re-evaluation when home-treated with oral antibiotics

Line Thousig Sehested; Konstantinos Kamperis; Louise Winding; Charlotte Kjær Bjerre; Mette Neland; Søren Hagstrøm; Line Kønig Wilms; Marie Louise Elkjær Andersen; Linda Kuhne-Qvist; Jette Skjøde Hoffmann-Petersen; Hanne Nørgaard; Dina Cortes

doi:10.1111/apa.15958

Children with acute pyelonephritis need medical re-evaluation when home-treated with oral antibiotics

Line Thousig Sehested^*, Konstantinos Kamperis, Louise Winding, Charlotte Kjær Bjerre, Mette Neland, Søren Hagstrøm, Line Kønig Wilms, Marie Louise Elkjær Andersen, Linda Kuhne-Qvist, Jette Skjøde Hoffmann-Petersen, Hanne Nørgaard, Dina Cortes

^*Corresponding author for this work

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

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Abstract

Aim: To investigate the efficacy and safety of home-treatment with oral piv-mecillinam or amoxicillin-clavulanate in children with acute pyelonephritis. Methods: Children aged over 6 months diagnosed with culture confirmed pyelonephritis at Danish Paediatric Departments were home-treated with piv-mecillinam (tablets) or amoxicillin-clavulanate (liquid or tablets). Follow-up was performed by phone (second treatment day) and clinical review of the patients in the hospital (day three). Results: Four hundred eighteen children were included. In total, 333/418 (80%) responded well to the initial oral antibiotic treatment. 85/418 (20%) were changed to another treatment of these 47/418 (11%) to a second-line oral antibiotic and 38/418 (9%) to intravenous antibiotics due to insufficient clinical improvement or bacterial resistance. Bacterial resistance was similar for piv-mecillinam and amoxicillin-clavulanate: 4/74 (5%) versus 33/333 (10%) (p = 0.22). Insufficient clinical improvement, despite no resistance, primarily occurred in children treated with piv-mecillinam: 16/74 (22%) versus 28/344 (8%) (p < 0.001), and predominantly occurred in piv-mecillinam treated children <5 years: 7/20 (35%) versus 9/54 (17%) (p < 0.05), potentially because of problems with piv-mecillinam tablets. In the study population no cases of death or septicemia developed after start of initial oral treatment. Conclusion: A home-treatment regime for pyelonephritis in children >6 months is safe; however, during treatment, clinical re-evaluation is required as in 20% of cases a change in treatment was necessary.

Original language	English
Journal	Acta Paediatrica, International Journal of Paediatrics
Volume	110
Issue	9
Pages (from-to)	2627-2634
Number of pages	8
ISSN	0803-5253
DOIs	https://doi.org/10.1111/apa.15958
Publication status	Published - Sept 2021

Keywords

amoxicillin-clavulanate
home-treatment
paediatrics
piv-mecillinam
pyelonephritis

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10.1111/apa.15958

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Sehested, L. T., Kamperis, K., Winding, L., Bjerre, C. K., Neland, M., Hagstrøm, S., Wilms, L. K., Andersen, M. L. E., Kuhne-Qvist, L., Hoffmann-Petersen, J. S., Nørgaard, H., & Cortes, D. (2021). Children with acute pyelonephritis need medical re-evaluation when home-treated with oral antibiotics. Acta Paediatrica, International Journal of Paediatrics, 110(9), 2627-2634. https://doi.org/10.1111/apa.15958

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title = "Children with acute pyelonephritis need medical re-evaluation when home-treated with oral antibiotics",

abstract = "Aim: To investigate the efficacy and safety of home-treatment with oral piv-mecillinam or amoxicillin-clavulanate in children with acute pyelonephritis. Methods: Children aged over 6 months diagnosed with culture confirmed pyelonephritis at Danish Paediatric Departments were home-treated with piv-mecillinam (tablets) or amoxicillin-clavulanate (liquid or tablets). Follow-up was performed by phone (second treatment day) and clinical review of the patients in the hospital (day three). Results: Four hundred eighteen children were included. In total, 333/418 (80%) responded well to the initial oral antibiotic treatment. 85/418 (20%) were changed to another treatment of these 47/418 (11%) to a second-line oral antibiotic and 38/418 (9%) to intravenous antibiotics due to insufficient clinical improvement or bacterial resistance. Bacterial resistance was similar for piv-mecillinam and amoxicillin-clavulanate: 4/74 (5%) versus 33/333 (10%) (p = 0.22). Insufficient clinical improvement, despite no resistance, primarily occurred in children treated with piv-mecillinam: 16/74 (22%) versus 28/344 (8%) (p < 0.001), and predominantly occurred in piv-mecillinam treated children <5 years: 7/20 (35%) versus 9/54 (17%) (p < 0.05), potentially because of problems with piv-mecillinam tablets. In the study population no cases of death or septicemia developed after start of initial oral treatment. Conclusion: A home-treatment regime for pyelonephritis in children >6 months is safe; however, during treatment, clinical re-evaluation is required as in 20% of cases a change in treatment was necessary.",

keywords = "amoxicillin-clavulanate, home-treatment, paediatrics, piv-mecillinam, pyelonephritis",

author = "Sehested, {Line Thousig} and Konstantinos Kamperis and Louise Winding and Bjerre, {Charlotte Kj{\ae}r} and Mette Neland and S{\o}ren Hagstr{\o}m and Wilms, {Line K{\o}nig} and Andersen, {Marie Louise Elkj{\ae}r} and Linda Kuhne-Qvist and Hoffmann-Petersen, {Jette Skj{\o}de} and Hanne N{\o}rgaard and Dina Cortes",

note = "Publisher Copyright: {\textcopyright} 2021 Foundation Acta P{\ae}diatrica. Published by John Wiley & Sons Ltd.",

year = "2021",

month = sep,

doi = "10.1111/apa.15958",

language = "English",

volume = "110",

pages = "2627--2634",

journal = "Acta Paediatrica, International Journal of Paediatrics",

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Sehested, LT, Kamperis, K, Winding, L, Bjerre, CK, Neland, M, Hagstrøm, S, Wilms, LK, Andersen, MLE, Kuhne-Qvist, L, Hoffmann-Petersen, JS, Nørgaard, H & Cortes, D 2021, 'Children with acute pyelonephritis need medical re-evaluation when home-treated with oral antibiotics', Acta Paediatrica, International Journal of Paediatrics, vol. 110, no. 9, pp. 2627-2634. https://doi.org/10.1111/apa.15958

Children with acute pyelonephritis need medical re-evaluation when home-treated with oral antibiotics. / Sehested, Line Thousig; Kamperis, Konstantinos; Winding, Louise et al.
In: Acta Paediatrica, International Journal of Paediatrics, Vol. 110, No. 9, 09.2021, p. 2627-2634.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Children with acute pyelonephritis need medical re-evaluation when home-treated with oral antibiotics

AU - Sehested, Line Thousig

AU - Kamperis, Konstantinos

AU - Winding, Louise

AU - Bjerre, Charlotte Kjær

AU - Neland, Mette

AU - Hagstrøm, Søren

AU - Wilms, Line Kønig

AU - Andersen, Marie Louise Elkjær

AU - Kuhne-Qvist, Linda

AU - Hoffmann-Petersen, Jette Skjøde

AU - Nørgaard, Hanne

AU - Cortes, Dina

PY - 2021/9

Y1 - 2021/9

N2 - Aim: To investigate the efficacy and safety of home-treatment with oral piv-mecillinam or amoxicillin-clavulanate in children with acute pyelonephritis. Methods: Children aged over 6 months diagnosed with culture confirmed pyelonephritis at Danish Paediatric Departments were home-treated with piv-mecillinam (tablets) or amoxicillin-clavulanate (liquid or tablets). Follow-up was performed by phone (second treatment day) and clinical review of the patients in the hospital (day three). Results: Four hundred eighteen children were included. In total, 333/418 (80%) responded well to the initial oral antibiotic treatment. 85/418 (20%) were changed to another treatment of these 47/418 (11%) to a second-line oral antibiotic and 38/418 (9%) to intravenous antibiotics due to insufficient clinical improvement or bacterial resistance. Bacterial resistance was similar for piv-mecillinam and amoxicillin-clavulanate: 4/74 (5%) versus 33/333 (10%) (p = 0.22). Insufficient clinical improvement, despite no resistance, primarily occurred in children treated with piv-mecillinam: 16/74 (22%) versus 28/344 (8%) (p < 0.001), and predominantly occurred in piv-mecillinam treated children <5 years: 7/20 (35%) versus 9/54 (17%) (p < 0.05), potentially because of problems with piv-mecillinam tablets. In the study population no cases of death or septicemia developed after start of initial oral treatment. Conclusion: A home-treatment regime for pyelonephritis in children >6 months is safe; however, during treatment, clinical re-evaluation is required as in 20% of cases a change in treatment was necessary.

AB - Aim: To investigate the efficacy and safety of home-treatment with oral piv-mecillinam or amoxicillin-clavulanate in children with acute pyelonephritis. Methods: Children aged over 6 months diagnosed with culture confirmed pyelonephritis at Danish Paediatric Departments were home-treated with piv-mecillinam (tablets) or amoxicillin-clavulanate (liquid or tablets). Follow-up was performed by phone (second treatment day) and clinical review of the patients in the hospital (day three). Results: Four hundred eighteen children were included. In total, 333/418 (80%) responded well to the initial oral antibiotic treatment. 85/418 (20%) were changed to another treatment of these 47/418 (11%) to a second-line oral antibiotic and 38/418 (9%) to intravenous antibiotics due to insufficient clinical improvement or bacterial resistance. Bacterial resistance was similar for piv-mecillinam and amoxicillin-clavulanate: 4/74 (5%) versus 33/333 (10%) (p = 0.22). Insufficient clinical improvement, despite no resistance, primarily occurred in children treated with piv-mecillinam: 16/74 (22%) versus 28/344 (8%) (p < 0.001), and predominantly occurred in piv-mecillinam treated children <5 years: 7/20 (35%) versus 9/54 (17%) (p < 0.05), potentially because of problems with piv-mecillinam tablets. In the study population no cases of death or septicemia developed after start of initial oral treatment. Conclusion: A home-treatment regime for pyelonephritis in children >6 months is safe; however, during treatment, clinical re-evaluation is required as in 20% of cases a change in treatment was necessary.

KW - amoxicillin-clavulanate

KW - home-treatment

KW - paediatrics

KW - piv-mecillinam

KW - pyelonephritis

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U2 - 10.1111/apa.15958

DO - 10.1111/apa.15958

M3 - Journal article

C2 - 34050973

AN - SCOPUS:85107778277

SN - 0803-5253

VL - 110

SP - 2627

EP - 2634

JO - Acta Paediatrica, International Journal of Paediatrics

JF - Acta Paediatrica, International Journal of Paediatrics

IS - 9

ER -

Children with acute pyelonephritis need medical re-evaluation when home-treated with oral antibiotics

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