Short versus long course antibiotic therapy for acute pyelonephritis in adults: a meta-analysis of randomised controlled trials

Abstract number: O201

Kyriakidou K., Rafailidis P., Athanassiou S., Matthaiou D., Falagas M.

Objective: Despite the high incidence of acute pyelonephritis in the community setting, there is no consensus on the optimal duration of treatment. To our knowledge, no quantitative synthesis has been previously performed investigating the issue of shortening the prevailing therapeutic schemes for the treatment of this disease.

Methods: We searched PubMed and Cochrane Central Register of Controlled Trials to identify and extract data from relevant RCTs for a meta-analysis comparing the effectiveness and toxicity of short versus long regimens for the treatment of acute pyelonephritis. Inclusion criteria were: RCTs involving adult patients with acute pyelonephritis and comparing regimens with the same antibiotic, in the same daily dosage but administered for a different duration of time (a short-course and a long-course).

Results According to our initial search, 205 potentially relevant articles were retrieved from PubMed and 136 from the Cochrane Central Register of Controlled Trials. Finally, 4 RCTs were eligible for inclusion in our meta-analysis. There was no difference between the short course treatment (7–10 days) and the long course treatment (14–21 days) for acute pyelonephritis regarding clinical success [odds ratio (OR)=1.27, 95% confidence interval (CI) 0.59–2.7] and microbiological eradication (OR=0.80, 95% CI 0.13–4.95), and relapse (OR=0.92, 95% CI 0.29–2.88). Also there was no difference between the short course and the long course treatment regarding adverse events (OR=0.57, 95% CI 0.29–1.11) and withdrawals due to adverse events (OR=0.37 95% CI 0.09–1.45)

Conclusions: The findings of our meta-analysis suggest that short course regimens are as effective and safe as long course regimens for the treatment of acute pyelonephritis. However, due to the relative scarcity of data, more RCTs focused on this important clinical question are needed in order to come to a definitive conclusion.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Location: Barcelona, Spain
Presentation type:
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