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

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.

[Secondary pseudohypoaldosteronism in neonates due to pyelonephritis and congenital urinary tract malformations]. / Sekundaer pseudohypoaldosteronisme hos spaedbørn med pyelonefritis og urogenitale misdannelser.

We report two cases of neonates with secondary pseudohypoaldosteronism due to pyelonephritis and congenital urinary tract malformations. Both patients presented with failure to thrive, dehydration, severe hyponatraemia and metabolic acidosis. One of the patients also developed severe hyperkalaemia. Secondary pseudohypoaldosteronism may resemble congenital adrenal hyperplasia. Early diagnosis is essential since both conditions, when untreated, are fatal, and treatment of the two differs significantly. Differential diagnosis may be achieved by acute analysis of urine culture and renal ultrasonography.