Outpatient treatment of acute pyelonephritis in pregnancy after 24 weeks. A randomised controlled trial

Abstract number: p1702

Ahmadinejad  Z., Hantooshzadeh  S.

Objectives: 

The purpose of this study was to compare the safety and efficacy of outpatient and inpatient treatment of acute pyelonephritis in pregnancy.

Methods: 

This was a randomized controlled, clinical trial. One hundred twenty eight gravidas past 24 weeks' gestation admitted in IMAM KHOMEINI hospital, Tehran & SAHID Dr BAHONAR hospital, Kerman, divided by random blocks to outpatient or inpatient therapy, received two 1-g doses of intramuscular ceftriaxone at 24-hour intervals while hospitalized, then were discharged and reevaluated within 48–72 hours or remained hospitalized until afebrile for 48 hours. All patients completed a 14-day course of oral cephalexin. We performed urine cultures on admission and 10–14 days after therapy.

Results: 

The two groups were similar with respect to age, parity, temperature, estimated gestational age, initial white blood cell count, and incidence of bacteremia. There were not any significant differences between two groups about the clinical improvement after 48–72 hours, bacteriuria 10–14 days after treatment, relapse of pyelonephritis, requirement to change in antibiotic, date of pregnancy at delivery and preterm labor. The relapse of bacteriuria and preterm labor in inpatients were significantly more than outpatients (PV = 0.0077 and 0.030 respectively). The birth weight of neonate in outpatients were significantly more than inpatients (PV = 0.013).

Conclusion: 

Outpatient antibiotic therapy is effective and safe in selected pregnant women with pyelonephritis. However in this study, the neonatal outcomes were better in outpatients and the maternal outcomes in inpatients.