ro13-9904 and Pyelonephritis

Children over 2 years of age with complicated acute pyelonephritis or at risk of complications should first be treated with a parenteral antibiotic, for example ceftriaxone, for 2 to 4 days, then switched to oral antibiotic therapy for a total treatment period of 10 to 14 days, taking into account the results of antimicrobial susceptibility testing. First-choice antibiotic therapy, in the absence of known risk, is oral cefixime for 7 days to 10 days. Second-line treatments include amoxicillin plus clavulanic acid or co-trimoxazole, taking account of the results of antimicrobial susceptibility testing.

Topics: Acute Disease; Anti-Bacterial Agents; Cefixime; Ceftriaxone; Child; Child, Preschool; Humans; Microbial Sensitivity Tests; Practice Guidelines as Topic; Pyelonephritis; Risk Factors

Topics: Anti-Bacterial Agents; Ceftriaxone; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Humans; Meningitis, Bacterial; Otitis; Pyelonephritis; Sexually Transmitted Diseases

This review focuses on antibiotic treatment of acute urinary tract infections (UTIs) in children who are neurologically and anatomically intact. Neonates younger than 28 days with a febrile UTI should be hospitalized, given supportive care and treated with parenteral amoxicillin and cefotaxime. Following a good response to 3 to 4 days of parenteral antibacterial therapy, outpatient treatment with an oral antibiotic should be given to complete 14 days of therapy. Infants from 28 days to 3 months who appear clinically ill with a febrile UTI should be hospitalized, receive supportive care and parenteral administration of a 3(rd) generation cephalosporin or gentamicin. When these infants are clinically improved and afebrile for 24 hours they should be discharged to complete 14 days of therapy with an oral antibiotic. Infants from 28 days to 3 months of age who are not acutely ill with a febrile UTI may be managed as outpatients. Ceftriaxone or gentamicin should be administered parenterally and given each 24 h until the infant is afebrile for 24 hours. Fourteen days of therapy should be completed with an oral antibiotic. Children with complicated pyelonephritis should be hospitalized, receive supportive care and parenteral ceftriaxone or gentamicin each 24 hours until clinically improved and without fever for 24 hours. They should then complete 10 to 14 days of therapy with an oral antibiotic as an outpatient. Children with uncomplicated pyelonephritis should be rehydrated in the outpatient department (if necessary) and receive parenteral ceftriaxone or gentamicin each 24 hours until without fever for 24 hours. If clinically improved they should receive an oral antibiotic to complete 10 to 14 days of therapy. Children with cystitis who are only mildly symptomatic should be managed with supportive care until the result of the urine culture and sensitivity are available. Children with cystitis who are moderately to severely symptomatic should receive an oral antibiotic and supportive care immediately. If the therapy is effective, children with cystitis should show a good clinical response in 2 to 3 days. If the response is satisfactory and the culture shows an organism susceptible to the antibiotic used, complete 5 to 7 days of treatment with the oral antibiotic.

Topics: Acute Disease; Administration, Oral; Adolescent; Age Factors; Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Cystitis; Gentamicins; Hospitalization; Humans; Infant; Infant, Newborn; Injections, Intravenous; Outpatients; Pyelonephritis; Time Factors; Urinary Tract Infections

Bilateral emphysematous pyelonephritis is a life threatening condition usually occurring in diabetics. Management of this condition has traditionally been aggressive and surgery is considered mandatory. However, this is itself a hazardous intervention in a septic, unstable patient with circulatory or liver failure. When bilateral disease is present, the need for long-term dialysis is obviously unavoidable.. We herein report one of the few cases of bilateral emphysematous pyelonephritis successfully managed by non-surgical treatment.

Topics: Adult; Amikacin; Cardiotonic Agents; Ceftriaxone; Diabetes Mellitus, Type 2; Dopamine; Emphysema; Female; Fluid Therapy; Humans; Hypoglycemic Agents; Insulin; Pyelonephritis; Radiography; Treatment Outcome

Ceftriaxone (CTRX) was evaluated for clinical efficacy on uncomplicated and complicated pyelonephritis by administering 2 g once daily for 5 days to 16 female patients between 20 and 65 years old (average: 39.7 years); i.e., 3 with uncomplicated pyelonephritis and 13 with complicated pyelonephritis. The pathogens in all 3 cases of uncomplicated pyelonephritis were E. coli. All of them disappeared after the treatment. Twenty-two strains of 10 strains of bacteria were isolated from the 13 cases of complicated pyelonephritis. Twenty of the 22 (91%) strains disappeared. The clinical efficacy was evaluated according to the Criteria for Evaluation of Clinical Efficacy of Antimicrobial Agents on UTI Japan in 15 cases except for 1 case of the complicated type where the CTRX administration was discontinued after the initial dose due to an adverse event. The efficacy rate was 100% in the 3 uncomplicated cases; 'excellent' in 1 case and 'good' in 2, and 92% in 12 of the complicated cases; 'excellent' in 9, 'good' in 2 and 'poor' in 1 (infection was with multiple pathogens including P. aeruginosa). No abnormal values were observed in any cases except for a slight increase in glutamic-pyruvic transaminase and alkaline phosphatase in one case and skin rash in another case which appeared following the initial dose and required the immediate withdrawal of the drug. CTRX is characterized by a long half-life and shows a strong antibacterial activity against GNRs, especially E. coli. The efficacy rate was high particularly following the initial dose in the acute stage of pyelonephritis.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Aged; Ceftriaxone; Drug Administration Schedule; Female; Humans; Middle Aged; Pyelonephritis

Acute pyelonephritis is among the most common bacterial infections. Options for initial treatment of pyelonephritis include an extended-spectrum cephalosporin or a fluoroquinolone. This study aimed to compare the clinical outcomes of patients receiving ceftriaxone to those who received levofloxacin for the treatment of acute pyelonephritis.. In this randomized, open-label trial, hospitalized adults with acute pyelonephritis were treated with ceftriaxone (1g IV every 12 hours) or levofloxacin (750 mg IV daily) for at least 7 days. Clinical and microbiological characteristics were compared among patients treated with ceftriaxone and levofloxacin.. A total of 59 patients were randomized, 30 to the ceftriaxone group and 29 to the levofloxacin group. The clinical response was that 68.0% of patients in the ceftriaxone group and 56.0% of patients in the levofloxacin group were cured. The microbiological response, i.e. pathogen eradication rates was 68.7% in the ceftriaxone group and 21.4% in the levofloxacin group. (P value=0.00028) Escherichia coli was the most common pathogen (n = 31), followed by Klebsiella pneumoniae (n = 21). High resistance rates were detected for cotrimoxazole (55%), ciprofloxacin (48%), and ceftriaxone (34.4%) in isolated E.coli. Likewise, all K. pneumoniae isolates were resistant to ciprofloxacin.. This study indicates that ceftriaxone was more effective than levofloxacin in the treatment of acute pyelonephritis, on the basis of microbiological response, but there were no statistically significant differences between the treatment groups in the rates of clinical cure. The resistance of uropathogens to the most used antibiotics was relatively high. Choosing the treatment regimen based on susceptibility testing results and shortening the duration of the therapy are now recommended to be the most important approaches to decrease the spread of antibiotic resistance worldwide.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Humans; Iran; Levofloxacin; Pyelonephritis; Urinary Tract Infections

To confirm whether oral antibiotic treatment is as efficacious as sequential intravenous/oral antibiotic treatment in the prevention of renal scarring in children with acute pyelonephritis and scintigraphy-documented acute lesions.. In a prospective multicenter trial, children aged 1 to 36 months with their first case of acute pyelonephritis, a serum procalcitonin concentration ≥0.5 ng/mL, no known uropathy, and a normal ultrasound exam were randomized into 2 treatment groups. They received either oral cefixime for 10 days or intravenous ceftriaxone for 4 days followed by oral cefixime for 6 days. Patients with acute renal lesions detected on early dimercaptosuccinic acid scintigraphy underwent a follow-up scintigraphy 6 to 8 months later.. The study included 171 infants and children. There were no significant differences between the 2 groups in any clinical characteristic. Initial scintigraphy results were abnormal for 119 children. Ninety-six children were measured for renal scarring at the follow-up scintigraphy (per protocol analysis population). The incidence of renal scarring was 30.8% in the oral treatment group and 27.3% for children who received the sequential treatment.. Although this trial does not statistically demonstrate the noninferiority of oral treatment compared with the sequential treatment, our study confirmed the results of previously published reports and therefore supports the use of an oral antibiotic treatment of primary episodes of acute pyelonephritis in infants and young children.

Topics: Acute Disease; Administration, Oral; Anti-Bacterial Agents; Calcitonin; Calcitonin Gene-Related Peptide; Cefixime; Ceftriaxone; Child, Preschool; Drug Administration Schedule; Escherichia coli Infections; Female; Humans; Infant; Infusions, Intravenous; Male; Prospective Studies; Protein Precursors; Pyelonephritis; Radionuclide Imaging

The efficacy and safety of ertapenem, 1 g once daily, were compared with that of ceftriaxone, 2 g once daily, for the treatment of adults with acute pyelonephritis (APN) and complicated urinary tract infections (cUTIs) in a prospective, multicenter, double-blinded, randomized study. After ≥ 3 days of parenteral study therapy, patients could be switched to an oral agent. Of 271 patients who were initially stratified by APN (n = 210) or other cUTIs (n = 61), 66 (48.9%) in the ertapenem group and 71 (52.2%) in the ceftriaxone group were microbiologically evaluable. The mean duration of parenteral and total therapy, respectively, was 5.6 and 13.8 days for ertapenem and 5.8 and 13.8 days for ceftriaxone. The most common pathogen was Escherichia coli. At the primary efficacy endpoint 5-9 days after treatment, 58 (87.9%) patients in the ertapenem group and 63 (88.7%) in the ceftriaxone had a favorable microbiological response. When compared by stratum and severity, the outcomes in the two groups were equivalent. The frequency and severity of drug-related adverse events were generally similar in both treatment groups. The results indicate that ertapenem is highly effective and safe for the treatment of APN and cUTIs.

Topics: Acute Disease; Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Double-Blind Method; Ertapenem; Humans; Odds Ratio; Pyelonephritis; Republic of Korea; Risk Factors; Urinary Tract Infections

To compare the clinical and bacteriological effectiveness of intravenous (IV) ceftriaxone followed by oral cefditoren pivoxil or IV ceftriaxone for acute pyelonephritis.. A prospective randomized controlled trial of patients with a presumptive diagnosis of acute pyelonephritis was performed. Daily 2g IV ceftriaxone was initially given to all patients. After day 3, patients who satisfied the criteria for switch therapy were randomized to either group A (IV ceftriaxone) or group B (oral cefditoren pivoxil 400mg once daily).. Eighty-two patients were enrolled; 41 (50%) patients in group A and 41 (50%) patients in group B were evaluated. There was no statistically significant difference in baseline characteristics between the two groups. Clinical cure was observed in 39 of 41 (95.1%) patients in group A and 41 of 41 (100%) patients in group B (p=0.15, 95% confidence interval (CI) -0.12 to 0.02). Urine bacteriological eradication was found in 63.4% in group A and 60% in group B (p=0.75, 95% CI -0.18 to 0.25). There was no statistically significant difference in adverse effects between the two treatment groups.. These data suggest that IV ceftriaxone followed by oral cefditoren pivoxil is highly effective and well-tolerated for the treatment of acute pyelonephritis, even for uropathogens with a high proportion of quinolone-resistant strains.

Topics: Acute Disease; Administration, Intravenous; Administration, Oral; Adult; Aged; Anti-Bacterial Agents; Ceftriaxone; Cephalosporins; Double-Blind Method; Drug Substitution; Female; Humans; Male; Middle Aged; Prospective Studies; Pyelonephritis; Treatment Outcome

The hypothesis was tested that oral antibiotic treatment in children with acute pyelonephritis and scintigraphy-documented lesions is equally as efficacious as sequential intravenous/oral therapy with respect to the incidence of renal scarring. A randomised multi-centre trial was conducted in 365 children aged 6 months to 16 years with bacterial growth in cultures from urine collected by catheter. The children were assigned to receive either oral ceftibuten (9 mg/kg once daily) for 14 days or intravenous ceftriaxone (50 mg/kg once daily) for 3 days followed by oral ceftibuten for 11 days. Only patients with lesions detected on acute-phase dimercaptosuccinic acid (DMSA) scintigraphy underwent follow-up scintigraphy. Efficacy was evaluated by the rate of renal scarring after 6 months on follow-up scintigraphy. Of 219 children with lesions on acute-phase scintigraphy, 152 completed the study; 80 (72 females, median age 2.2 years) were given ceftibuten and 72 (62 females, median age 1.6 years) were given ceftriaxone/ceftibuten. Patients in the intravenous/oral group had significantly higher C-reactive protein (CRP) concentrations at baseline and larger lesion(s) on acute-phase scintigraphy. Follow-up scintigraphy showed renal scarring in 21/80 children treated with ceftibuten and 33/72 with ceftriaxone/ceftibuten (p = 0.01). However, after adjustment for the confounding variables (CRP and size of acute-phase lesion), no significant difference was observed for renal scarring between the two groups (p = 0.2). Renal scarring correlated with the extent of the acute-phase lesion (r = 0.60, p < 0.0001) and the grade of vesico-ureteric reflux (r = 0.31, p = 0.03), and was more frequent in refluxing renal units (p = 0.04). The majority of patients, i.e. 44 in the oral group and 47 in the intravenous/oral group, were managed as out-patients. Side effects were not observed. From this study, we can conclude that once-daily oral ceftibuten for 14 days yielded comparable results to sequential ceftriaxone/ceftibuten treatment in children aged 6 months to 16 years with DMSA-documented acute pyelonephritis and it allowed out-patient management in the majority of these children.

Topics: Administration, Oral; Adolescent; Anti-Bacterial Agents; Ceftibuten; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Drug Administration Schedule; Female; Humans; Infant; Injections, Intravenous; Male; Pyelonephritis; Radionuclide Imaging; Technetium Tc 99m Dimercaptosuccinic Acid

We report a prospective, randomized, multicenter trial that compared the effect of 3 vs 8 days of intravenous ceftriaxone treatment on the incidence of renal scarring at 6 to 9 months of follow-up in 383 children with a first episode of acute pyelonephritis.. After initial treatment with intravenous netilmicin and ceftriaxone, patients were randomly assigned to either 5 days of oral antibiotics (short intravenous treatment) or 5 days of intravenous ceftriaxone (long intravenous treatment). Inclusion criteria were age 3 months to 16 years and first acute pyelonephritis episode, defined by fever of >38.5 degrees C, C-reactive protein level of >20 mg/L, and bacteriuria at >10(5)/mL. All patients underwent 99m technetium-dimercaptosuccinic acid scintigraphy 6 to 9 months after inclusion. A total of 548 children were included, 48 of whom were secondarily excluded and 117 of whom were lost to follow-up or had incomplete data; therefore, 383 children were eligible, 205 of them in the short intravenous treatment group and 178 in the long intravenous treatment group.. At inclusion, median age was 15 months, median duration of fever was 43 hours, and median C-reactive protein level was 122 mg/L. A total of 37% (143 of 383) of patients had a vesicoureteral reflux grades 1 to 3. Patient characteristics at inclusion were similar in both groups, except for a significantly higher proportion of girls in the short intravenous treatment group. The frequency of renal scars at scintigraphy was similar in both groups. Multivariate analysis demonstrated that renal scars were significantly associated with increased renal height at initial ultrasound and with the presence of grade 3 vesicoureteric reflux.. The incidence of renal scars was similar in patients who received 3 days compared 8 days of intravenous ceftriaxone. Increased renal height at initial ultrasound examination and grade 3 vesicoureteric reflux were significant risk factors for renal scars.

Topics: Acute Disease; Adolescent; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Confidence Intervals; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Infant; Infusions, Intravenous; Kidney Function Tests; Logistic Models; Male; Netilmicin; Odds Ratio; Prospective Studies; Pyelonephritis; Radionuclide Imaging; Risk Assessment; Severity of Illness Index; Succimer; Time Factors; Treatment Outcome

To compare the efficacy of oral antibiotic treatment alone with treatment started parenterally and completed orally in children with a first episode of acute pyelonephritis.. Multicentre, randomised controlled, open labelled, parallel group, non-inferiority trial.. 28 paediatric units in north east Italy.. 502 children aged 1 month to <7 years with clinical pyelonephritis.. Oral co-amoxiclav (50 mg/kg/day in three doses for 10 days) or parenteral ceftriaxone (50 mg/kg/day in a single parenteral dose) for three days, followed by oral co-amoxiclav (50 mg/kg/day in three divided doses for seven days). Main outcomes measures Primary outcome was the rate of renal scarring. Secondary measures of efficacy were time to defervescence (<37 degrees C), reduction in inflammatory indices, and percentage with sterile urine after 72 hours. An exploratory subgroup analysis was conducted in the children in whom pyelonephritis was confirmed by dimercaptosuccinic acid (DMSA) scintigraphy within 10 days after study entry.. Intention to treat analysis showed no significant differences between oral (n=244) and parenteral (n=258) treatment, both in the primary outcome (scarring scintigraphy at 12 months 27/197 (13.7%) v 36/203 (17.7%), difference in risk -4%, 95% confidence interval -11.1% to 3.1%) and secondary outcomes (time to defervescence 36.9 hours (SD 19.7) v 34.3 hours (SD 20), mean difference 2.6 (-0.9 to 6.0); white cell count 9.8x10(9)/l (SD 3.5) v 9.5x10(9)/l (SD 3.1), mean difference 0.3 (-0.3 to 0.9); percentage with sterile urine 185/186 v 203/204, risk difference -0.05% (-1.5% to 1.4%)). Similar results were found in the subgroup of 278 children with confirmed acute pyelonephritis on scintigraphy at study entry.. Treatment with oral antibiotics is as effective as parenteral then oral treatment in the management of the first episode of clinical pyelonephritis in children.. Clinical Trials NCT00161330 [ClinicalTrials.gov].

Topics: Administration, Oral; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Ceftriaxone; Child; Child, Preschool; Cicatrix; Drug Administration Schedule; Drug Therapy, Combination; Humans; Infant; Infusions, Parenteral; Length of Stay; Pyelonephritis; Radionuclide Imaging; Treatment Outcome

The efficacy and safety of parenteral ertapenem, a Group 1 carbapenem, 1 g once a day, for the treatment of complicated urinary tract infections (UTIs; i.e. acute pyelonephritis, UTI in men, or UTI associated with obstruction, foreign body or a urological abnormality interfering with normal voiding) in adults, were compared with those of parenteral ceftriaxone, 1 g once a day, in two similarly designed prospective, double-blind, randomized studies. In both studies, patients could be switched to an oral agent after > or = 3 days of parenteral study therapy. At entry, 850 patients were stratified according to whether they had acute pyelonephritis or other complicated UTI without acute pyelonephritis. Two hundred and fifty-six patients in the ertapenem group and 224 in the ceftriaxone group were microbiologically evaluable. Ninety-six per cent of these patients were switched to oral therapy, usually ciprofloxacin; the median (range) duration of parenteral and total therapy, respectively, was 4 (2-14) days and 13 (14-18) days for ertapenem and 4 (2-14) days and 13 (3-17) days for ceftriaxone. The most common pathogens were Escherichia coli and Klebsiella pneumoniae, which accounted for 64.7% and 9.8% of isolates, respectively. At the primary efficacy endpoint 5-9 days after treatment, 229 (89.5%) patients who received ertapenem and 204 (91.1%) patients who received ceftriaxone had a favourable microbiological response (95% confidence interval, -7.4 to 4.0), indicating that outcomes in the two treatment groups were equivalent. Success rates in both treatment groups were similar when compared by stratum and severity of infection. The frequency and severity of drug-related adverse events were generally similar in both treatment groups. In this combined analysis, ertapenem was highly effective therapy for the treatment of complicated UTIs in adults with moderate-to-severe disease.

Topics: Acute Disease; Administration, Oral; Adolescent; Adult; Aged; Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Double-Blind Method; Drug Administration Schedule; Ertapenem; Female; Gram-Negative Bacteria; Gram-Positive Cocci; Humans; Lactams; Male; Middle Aged; Multicenter Studies as Topic; Pyelonephritis; Randomized Controlled Trials as Topic; Treatment Outcome; Urinary Tract Infections

To compare the short-term effectiveness of ceftriaxone single dose followed by cefixime with a standard treatment of acute uncomplicated pyelonephritis in women.. An open, prospective, and randomised trial of women with acute uncomplicated pyelonephritis was performed. Group A were given a daily intravenous dose of 1 g ceftriaxone; group B: ceftriaxone 1 g intravenous single dose followed by oral cefixime. When urine culture was received, both groups completed a 10 day treatment based in sensitivity studies. Only women with positive initial urine culture were included. After three days of treatment, clinical and bacteriological efficacy was assessed. Clinical response was classified as "cured" if acute symptoms (fever, urinary syndrome and flank pain) were settled. Bacteriological response was classified as: eradication, or no eradication.. Of 144 eligible patients, urine culture was positive in 54 of 72 (75%) women in group A and 51 of 72 (71%) in group B. There were no significant differences between groups in resolution of acute symptoms. Clinical cure was observed in 49 of 54 (91%) patients in the group A and in 47 of 51 (92%) patients in the group B (p = 0.68). After three days of treatment urine culture was negative for all patients. No adverse effects were observed in either of the groups.. These data suggest that a intravenous single dose of ceftriaxone followed by oral cefixime is both effective and safe for the initial treatment of acute uncomplicated pyelonephritis in women. This regimen could be useful in managing selected patients with pyelonephritis as outpatients.

Topics: Acute Disease; Adult; Cefixime; Ceftriaxone; Cephalosporins; Female; Humans; Middle Aged; Prospective Studies; Pyelonephritis

Acute pyelonephritis often leaves children with permanent renal scarring.. To compare the prevalence of scarring following initial treatment with antibiotics administered intravenously for 10 or three days.. In a prospective two centre trial, 220 patients aged 3 months to 16 years with positive urine culture and acute renal lesions on initial DMSA scintigraphy, were randomly assigned to receive intravenous ceftriaxone (50 mg/kg once daily) for 10 or three days, followed by oral cefixime (4 mg/kg twice daily) to complete a 15 day course. After three months, scintigraphy was repeated in order to diagnose renal scars.. Renal scarring developed in 33% of the 110 children in the 10 day intravenous group and 36% of the 110 children in the three day group. Children older than 1 year had more renal scarring than infants (42% (54/129) and 24% (22/91), respectively). After adjustment for age, sex, duration of fever before treatment, degree of inflammation, presence of vesicoureteric reflux, and the patients' recruitment centres, there was no significant difference between the two treatments on renal scarring. During follow up, 15 children had recurrence of urinary infection with no significant difference between the two treatment groups.. In children with acute pyelonephritis, initial intravenous treatment for 10 days, compared with three days, does not significantly reduce the development of renal scarring.

Topics: Acute Disease; Adolescent; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Cicatrix; Drug Administration Schedule; Female; Humans; Infant; Kidney Diseases; Male; Pyelonephritis; Radionuclide Imaging; Regression Analysis; Statistics, Nonparametric; Treatment Outcome

The available oral third generation of cephalosporin, "ceftibuten" was used to substitute the intravenous drug after defervescence in acute pyelonephritis in children. This randomized controlled study compared the efficacy of an oral ceftibuten switch therapy with a ceftriaxone in both short-term and long-term outcomes. 36 99mTc-dimercaptosuccinic acid (DMSA) scan proved pyelonephritis patients were randomized into the study group, "ceftibuten" (N=18) and the control group, "ceftriaxone" (N=18). Ceftriaxone (75 mg/kg/day) was the initial antibiotic in both groups. After defervescence for 24-48 hours, oral ceftibuten (9 mg/kg/day) was substituted in the study group and continued for 10 days. The subject characteristics and laboratory data were not different between the two groups. The urine culture at D14 was sterilized in both groups. The incidence of renal scarring was 66.6 per cent and 61.1 per cent in the study group and the control group respectively. The rate of recurrent infection showed no statistical significance. The duration of hospitalization was shorter in the study group than in the control. In conclusion, oral ceftibuten switch therapy can be recommended as a safe and effective treatment for acute pyelonephritis in children. The use of oral therapy may result in a significant reduction of health care expenditure.

Topics: Acute Disease; Administration, Oral; Adolescent; Ceftibuten; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Injections, Intravenous; Male; Prospective Studies; Pyelonephritis; Reference Values; Treatment Outcome

To compare the effectiveness of three antibiotic regimens for the treatment of acute pyelonephritis in pregnancy.. One hundred seventy-nine pregnant women earlier than 24 weeks' gestation who had acute pyelonephritis were randomized to 1) intravenous (i.v.) ampicillin and gentamicin, 2) i.v. cefazolin, or 3) intramuscular ceftriaxone. All participants then completed 10-day courses of oral cephalexin after primary treatment. A urine culture was performed on admission and 5-14 days after completion of therapy. Surveillance for persistent or recurrent infection and obstetric complications continued until delivery. On the basis of a two-sided hypothesis test and with alpha = .025, 60 subjects were needed in each group for statistical power greater than 80% to detect a difference between ceftriaxone and other antibiotics if hospital length of stay differed by 1 or more days.. The treatment groups were similar in age, parity, temperature, gestational age, and initial white blood cell count. There were no statistically significant differences in length of hospitalization, hours until becoming afebrile, days until resolution of costovertebral angle tenderness, or infecting organism. There were no statistically significant differences in birth outcomes between the three groups. The average (standard deviation) age at delivery was 38.8 +/- 3.6 weeks. The average birth weight was 3274 +/- 523 g. Eleven (6.9%) of 159 subjects delivered prematurely. Escherichia coli was the most common uropathogen isolated (137 of 179, 76.5%). Blood cultures were positive for organisms in 15 cases (8.4%). At follow-up examination within 2 weeks of initial therapy, eight (5.0%) of 159 subjects had urine cultures positive for organisms. Ten women (6.3%) had cultures positive for organisms later in their antepartum course, and 10 other participants (6.3%) developed recurrent pyelonephritis.. There are no significant differences in clinical response to antimicrobial therapy or birth outcomes among subjects treated with ampicillin and gentamicin, cefazolin, or ceftriaxone for acute pyelonephritis in pregnancy before 24 weeks' gestation.

Topics: Acute Disease; Adult; Ampicillin; Anti-Bacterial Agents; Cefazolin; Ceftriaxone; Female; Gentamicins; Humans; Infant, Newborn; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Pyelonephritis

It is very important to treat patients with upper urinary tract infections (UTIs) promptly and effectively because of the potential sequelae. In the present study we compare the efficacy of the two cephalosporins, ceftriaxone and cefotaxime, in childhood pyelonephritis. The study protocal included 10 days of drug therapy. Both in patients receiving ceftriaxone and cefotaxime, successful eradication was achieved at the second day of therapy. The overall cure rate was significantly better in the ceftriaxone group than the cefotaxime group in terms of recurrence and reinfections (p < 0.05). Furthermore, in the complicated group, ceftriaxone was slightly superior to cefotaxime, approaching significance in terms of preventing recurrent infections. No serious adverse effects were observed in either of the groups. The present study has shown that ceftriaxone exhibits favorable clinical and bacteriologic efficacy in patients with complicated and uncomplicated upper UTI. Once-daily injection of ceftriaxone in children is also an attractive advantage of the drug when compared to twice-daily cefotaxime.

Topics: Adolescent; Bacteriuria; Cefotaxime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Double-Blind Method; Enterobacteriaceae; Female; Humans; Male; Pyelonephritis; Radiography; Urinary Tract Infections

The disposition of ornidazole and its two major hydroxylated metabolites was studied in five pregnant women (gestational ages 25 5/7 to 38 4/7 weeks) with either chorioamnionitis or pyelonephritis treated with ceftriaxone 2 g, tobramycin 3 mg/kg body weight and ornidazole 1 g all administered once-daily. Two series of blood samples were obtained, the first on the first day of treatment and the second at steady-state on day 5. Local and systemic tolerability of ornidazole was excellent and patients showed complete remission without premature delivery. There was no evidence of ornidazole accumulation, and the pharmacokinetic parameters were very similar to those seen in healthy subjects. The dosage regimen of ornidazole therefore requires no adjustment during pregnancy. Trough concentrations of ornidazole measured at 24 h post dose were above the MIC of sensitive organisms. Children born to the trial patients showed normal initial development and their growth was normal.

Topics: Adult; Ceftriaxone; Chorioamnionitis; Drug Therapy, Combination; Escherichia coli Infections; Female; Humans; Infant, Newborn; Ornidazole; Pregnancy; Pregnancy Complications, Infectious; Proteus Infections; Pyelonephritis; Tobramycin

To compare the safety and efficacy of outpatient and inpatient treatment of pyelonephritis in pregnancy.. We performed a randomized controlled trial of pregnant women with pyelonephritis before 24 weeks' estimated gestational age, comparing inpatient and outpatient treatment. Sixty inpatients received cefazolin intravenously until afebrile for 48 hours, and 60 outpatients received two injections of ceftriaxone intramuscularly. All patients completed a 10-day course of oral cephalexin. We performed a urine culture 5-14 days after completion of therapy.. The two groups were similar with respect to age, parity, temperature, estimated gestational age, initial white blood cell count, and incidence of bacteremia. Escherichia coli was the major uropathogen isolated (86% of cultures, 95 of 111). Twelve percent (13 of 111) of bacteria were resistant to cefazolin. Eleven outpatients and 12 inpatients had positive urine cultures after therapy (relative risk 0.9, 95% confidence interval 0.4-1.9). Three patients in each group had recurrent pyelonephritis. We switched six inpatients to gentamicin because of a worsening clinical picture (two) or a prolonged febrile course (four); no outpatients required a change in antibiotic (Fisher exact test, P = .03). One preterm delivery occurred in an inpatient with recurrent pyelonephritis.. Outpatient antibiotic therapy is effective and safe in selected pregnant women with pyelonephritis.

Topics: Administration, Oral; Adult; Ambulatory Care; Cefazolin; Ceftriaxone; Cephalexin; Drug Therapy, Combination; Female; Hospitalization; Humans; Injections, Intramuscular; Injections, Intravenous; Pregnancy; Pregnancy Complications; Pyelonephritis

The purpose of this study was to compare the efficacy of a single daily dose of intravenous ceftriaxone with that of multiple-dose cefazolin in the treatment of acute pyelonephritis in pregnancy.. This was a double-blind, randomized, clinical trial. Patients admitted to the hospital with the diagnosis of acute pyelonephritis in pregnancy were enrolled and randomized according to a computer-generated randomization schedule. The study group received a single daily 1 gm dose of ceftriaxone intravenously along with two additional doses of normal saline solution. The comparison group received three daily 2 gm doses of cefazolin intravenously. All infusions were given on an 8-hour schedule. Treatments were continued until the patient became afebrile. Each patient was discharged from the hospital on a regimen of appropriate oral antibiotics as directed by urine culture and sensitivities. At follow-up visits test-of-cure cultures were obtained.. During the 2-year study period, 178 patients were randomized: 88 received cefazolin and 90 ceftriaxone. Patient demographics and presenting signs and symptoms were similar in both groups. No differences were noted between the groups regarding days of febrile morbidity, length of hospital stay, or treatment failures.. Daily single-dose intravenous ceftriaxone is as effective as multiple-dose cefazolin in the treatment of patients with acute pyelonephritis during pregnancy.

Topics: Adult; Cefazolin; Ceftriaxone; Double-Blind Method; Drug Administration Schedule; Female; Humans; Infant; Infusions, Intravenous; Pregnancy; Pregnancy Complications, Infectious; Pyelonephritis; Treatment Outcome

Ceftriaxone, a third-generation cephalosporin with a long half-life, was administered intramuscularly to 30 adult women suffering from acute pyelonephritis. Standard bacteriologic methods were used to identify the pathogens and their susceptibilities before treatment and at intervals during and after treatment. Overall cure was achieved in 25 (85%) of the patients 6 weeks after completion of therapy. The results demonstrate that ceftriaxone is an effective drug when given once a day intramuscularly to out-patients with acute pyelonephritis.

Topics: Acute Disease; Adult; Aged; Ambulatory Care; Bacteria; Ceftriaxone; Drug Administration Schedule; Female; Humans; Injections, Intramuscular; Middle Aged; Pyelonephritis

Topics: Acute Disease; Adult; Ampicillin; Ceftriaxone; Cost-Benefit Analysis; Drug Therapy, Combination; Female; Gentamicins; Humans; Male; Prospective Studies; Pyelonephritis

Scrub typhus can present with atypical signs and symptoms such as those of acute kidney injury, gastroenteritis, pneumonitis, and acute respiratory distress syndrome. Meningitis, encephalitis, and hepatic dysfunction have also been reported, particularly in severe cases with multisystem involvement. Scrub typhus has never been reported in the literature to cause urinary tract infections (UTIs) which includes cystitis and pyelonephritis.. A 45-year old male presenting to the outpatient unit with fever, right flank pain, and burning micturition for three days was initially treated for UTI. However, he returned to the hospital on the fourth day of illness with persistent symptoms. He was hospitalized, with intravenous (IV) ceftriaxone. Computerized tomography scan of his abdomen-pelvis showed features of acute pyelonephritis, so his antibiotics were upgraded to meropenem and teicoplanin. Despite this, the patient's condition deteriorated. Laboratory investigations showed multisystem involvement: decreasing platelets, raised creatinine, and deranged liver panel. As Kathmandu was hit by dengue epidemic during the patient's hospitalization, on the seventh day of his illness, blood samples were sent for tropical fever investigation. All tests came out negative except for scrub typhus-IgM antibodies positive on rapid diagnostic test. The patient's symptoms subsided after 48 h of starting doxycycline and he became fully asymptomatic four days later. Fever did not recur even after discontinuing other IV antibiotics, favoring scrub typhus disease rather than systemic bacterial sepsis.. Scrub typhus is an emerging infectious disease of Nepal. Therefore, every unexplained fever cases (irrespective of clinical presentation) should be evaluated for potential Rickettsiosis. Moreover, for cases with acute pyelonephritis, atypical causative agents should be investigated, for example scrub typhus in this case.

Topics: Anti-Bacterial Agents; Ceftriaxone; Communicable Diseases, Emerging; Doxycycline; Fever; Humans; Male; Meropenem; Middle Aged; Nepal; Pyelonephritis; Scrub Typhus; Teicoplanin

Topics: Aged; Anti-Bacterial Agents; Ceftriaxone; Confusion; Delirium; Dysuria; Female; Fever; Hospitalization; Humans; Neuroimaging; Pyelonephritis; Surveys and Questionnaires

Salmonella species are a very rare cause of urinary tract infection in healthy children. This species is associated with a high incidence of genitourinary abnormalities and immune deficiencies. We report the first pediatric case of a healthy 9-year-old girl with pyelonephritis due to Salmonella Anatum.

Topics: Anti-Bacterial Agents; Ceftriaxone; Child; Drug Resistance, Multiple, Bacterial; Female; Humans; Microbial Sensitivity Tests; Pyelonephritis; Salmonella; Salmonella Infections; Treatment Outcome; Urinary Tract Infections

Topics: Abdomen; Anti-Bacterial Agents; Ceftriaxone; Emphysema; Humans; Male; Middle Aged; Pelvis; Pneumorrhachis; Pyelonephritis; Tomography Scanners, X-Ray Computed

Topics: Abscess; Animals; Anti-Bacterial Agents; Ceftriaxone; Cicatrix; Humans; Hydronephrosis; Inflammation; Kidney; Kidney Function Tests; Male; Mice, Inbred C3H; Pyelonephritis; Treatment Outcome

Staphylococcus saprophyticus is resistant to the drugs most often used for the empirical treatment of urinary tract infections (UTI). The adequacy of antimicrobial treatments prescribed for UTI due to S. saprophyticus is not usually questioned. This study described the epidemiology of such infections and assessed the susceptibility of S. saprophyticus to ceftriaxone and amoxicillin-clavulanic acid.. Methicillin-susceptible S. saprophyticus (MSSS) isolated from clinical samples between November 2014 and July 2016 were included. Clinical data were recorded. The minimum inhibitory concentrations (MICs) of amoxicillin-clavulanic acid and ceftriaxone were measured for these MSSS strains and for 17 randomly selected methicillin-susceptible Staphylococcus aureus (MSSA) strains.. Of the S. saprophyticus isolates from urine, 59.5% were associated with a diagnosis of cystitis and 33.3% with pyelonephritis. Sixty percent of S. saprophyticus cystitis cases and 25% of pyelonephritis cases were given an inappropriate antibiotic regimen. The MICs of ceftriaxone ranged from 4 to >32μg/ml for MSSS, and from 1.5 to 4μg/ml for MSSA.. Many UTIs were treated with an empirical antibiotic therapy that was ineffective for S. saprophyticus, revealing that S. saprophyticus is an aetiology that is insufficiently considered in UTI. High MICs for ceftriaxone in MSSS were observed, which raises questions about the use of this antibiotic in UTIs due to S. saprophyticus.

Topics: Adolescent; Adult; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; beta-Lactams; Ceftriaxone; Cystitis; Drug Resistance, Multiple, Bacterial; Empirical Research; Female; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Pyelonephritis; Staphylococcus saprophyticus; Urinary Tract Infections; Young Adult

Acute focal bacterial nephritis (AFBN) is a complicated form of acute pyelonephritis (APN) characterized by single or multiple areas of localised infection in the kidney without liquefaction or abscess. Studies investigating AFBN in adults are scarce.. The present study was aimed at evaluating the prevalence, associated factors, and presence of atypical clinical and radiological manifestations in adult AFBN patients. Also, we developed a clinical prediction model to evaluate the probability of AFBN in patients with APN.. The clinical records of 377 patients (mean age 54years, 74.0% females) admitted to a hospital over a 5-year period with APN were reviewed.. A total of 57 cases of AFBN were radiologically identified (prevalence, 15.1%). Patients with AFBN were younger and displayed atypical manifestations more frequently than patients without AFBN; these included both clinical and radiological (pleural effusion, gallbladder wall thickening, fluid around the gallbladder, perirenal fluid, and ascites) manifestations. Patients with AFBN showed lower systolic blood pressure and needed more days of therapy to become afebrile, longer total duration of antibiotic therapy, and longer hospital stay than patients without AFBN. Contraceptive use was more frequent in patients with AFBN. A model based on five clinical variables showed good discrimination performance for the diagnosis of AFBN (Area under the curve, 0.77 (95% CI, 0.69-0.89)).. Patients with AFBN frequently present with atypical clinical and radiological manifestations. Clinical presentation by means of a predictive model may predict the presence of AFBN. Patients with AFBN need more intensive therapy, which is followed by a favourable outcome.

Topics: Acute Disease; Adult; Aged; Anti-Bacterial Agents; Bacterial Infections; Ceftriaxone; Female; Humans; Kidney; Logistic Models; Male; Middle Aged; Multivariate Analysis; Nephritis; Pyelonephritis; Retrospective Studies; Risk Factors; Spain; Tomography, X-Ray Computed; Ultrasonography; Young Adult

The emergence of resistant Escherichia coli to fluoroquinolones (FQs) is of growing concern, yet the latest guidelines for the treatment of pyelonephritis still recommend FQs as first-line treatment. Our primary objective was to determine the impact of discordant prescribing of FQs in E coli pyelonephritis on hospital length of stay (LOS) and early clinical response (ECR).. We retrospectively compared discordant and concordant prescribing of FQs for LOS and ECR. We also compared FQs, ceftriaxone, piperacillin/tazobactam, and carbapenems for these clinical outcomes.. Forty-nine patients included in the comparison between discordant (n = 9) and concordant (n = 40) prescribing of FQs. There was significantly lower ECR in patients with discordant prescribing of FQs (38 of 40, 95% vs 5 of 9, 55.6%, P = .0074) and a trend toward longer LOS (4 [2.3] days vs 3 [2.0] days, P = .0571). Illness severity, estimated using Simplified Acute Physiology Score (SAPS II) score, was similar between groups (P = .717).. There was a significantly decreased ECR and a trend toward increased LOS when FQs were used in FQ-resistant E coli. Regarding alternative treatment for E coli pyelonephritis, ceftriaxone was as effective as concordant FQs and significantly better than discordant FQs.

Topics: Adult; Anti-Bacterial Agents; Carbapenems; Ceftriaxone; Drug Resistance, Bacterial; Escherichia coli Infections; Female; Fluoroquinolones; Guidelines as Topic; Humans; Length of Stay; Male; Middle Aged; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pyelonephritis; Retrospective Studies; Treatment Outcome

Literature is lacking regarding the utilization of first-generation cephalosporins for the treatment of acute pyelonephritis. The aim of this study was to determine whether cefazolin is non-inferior to ceftriaxone for the empirical treatment of acute pyelonephritis in hospitalized patients. The primary outcome included a composite of symptomatic resolution plus either defervescence at 72 h or normalization of serum white blood cell count at 72 h (non-inferiority margin 15%). Secondary outcomes included length of stay and 30 day readmission. A subgroup analysis of the composite outcome was also conducted for imaging-confirmed pyelonephritis.. This was a retrospective, non-inferiority, multicentre, cohort study comparing cefazolin versus ceftriaxone for the empirical treatment of acute pyelonephritis in hospitalized patients.. Overall, 184 patients received one of the two treatments between July 2009 and March 2015. The composite outcome was achieved in 80/92 (87.0%) in the cefazolin group versus 79/92 (85.9%) in the ceftriaxone group (absolute difference 1.1%, 95% CI -11.1% to 8.9%, P = 0.83), meeting the pre-defined criteria for non-inferiority. The composite outcome for patients with imaging-confirmed pyelonephritis was achieved in 46/56 (82.1%) versus 42/50 (84.0%) for the cefazolin group and the ceftriaxone group, respectively (absolute difference 1.9%, 95% CI -12.8% to 16.5%, P = 0.80). Additionally, there were no statistically significant differences in length of stay or 30 day readmission for cystitis or pyelonephritis.. Cefazolin was non-inferior to ceftriaxone with regard to clinical response for the treatment of hospitalized patients with acute pyelonephritis in this study. No difference was observed for length of stay or 30 day readmission.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefazolin; Ceftriaxone; Cephalosporins; Cohort Studies; Empirical Research; Escherichia coli; Escherichia coli Infections; Female; Hospitalization; Humans; Length of Stay; Leukocyte Count; Male; Middle Aged; Patient Readmission; Pyelonephritis; Retrospective Studies; Young Adult

Topics: Abdominal Pain; Adult; Anti-Bacterial Agents; Ceftriaxone; Emergency Service, Hospital; Female; Humans; Methemoglobinemia; Phenazopyridine; Pyelonephritis

A 54-year-old male with long-standing diabetes presented with vague left flank pain for 5 days with uncontrolled blood glucose. The patient was commenced on insulin and injectable ceftriaxone empirically, for possibly acute pyelonephritis. Ultrasound examination revealed extensive emphysematous pyelonephritis of upper half of left kidney with involvement of perinephric space. Computed tomography of abdomen confirmed the diagnosis of emphysematous pyelonephritis which was categorised as class IIIa. The recommended treatment for class IIIa emphysematous pyelonephritis is nephrectomy but the patient refused to give consent for surgery or even percutaneous drainage. Thus, the patient was continued on medical management alone and surprisingly showed marked recovery over the next few days. There were no new complications, and the patient was discharged after 2 weeks of antibiotics with 2 more weeks of oral antibiotics. After 4 months, the ultrasound showed normal kidneys. We present this case because it adds to the little existing evidence that conservative management can successfully cure patients with class IIIa emphysematous pyelonephritis, although supplementation with percutaneous drainage would have been better in this case.

Topics: Anti-Bacterial Agents; Ceftriaxone; Diabetic Nephropathies; Emphysema; Humans; Hypoglycemic Agents; Insulin; Kidney; Male; Middle Aged; Pyelonephritis; Treatment Outcome; Ultrasonography

Ceftriaxone is frequently administered empirically for hospitalized patients with acute pyelonephritis (APN) due to prevalent quinolone resistance in our hospital; however, its use is inappropriate for extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, an increasing problem.. A retrospective, 1:2 matched cohort study was performed to evaluate the impact of ESBL on APN treated with empirical ceftriaxone. Each patient in ESBL group was matched with two patients in the non-ESBL group, using a 16-point scoring system, which included age, sex, bacteremia, simplified acute physiology score 2, Charlson comorbidity index and APN severity score.. From 2009 to 2011, among 1,322 community-onset cases of the E. coli bacteriuria with 212 (16%) ESBL producers, 261 patients with APN were treated empirically with ceftriaxone in a secondary care hospital. Among these 261 cases, twenty-six patients in the ESBL group and 52 matched patients in the non-ESBL group (1:2) were included. Mean time to defervescence was 4.6±2.2 days in the ESBL group and 2.6±1.3 days in the non-ESBL group (p<0.01). Rate of microbiological resolution within 5 days after antibiotic treatment was 77% (17/22) in the ESBL group and 100% (45/45) in the non-ESBL group (p=0.01). The duration of hospitalization was 13.3±8.2 days in the ESBL group and 7.3±3.5 days in the non-ESBL group (p<0.01). No patient died in either group.. Empirical ceftriaxone therapy for APN caused by ESBL-producing E. coli is inappropriate, and consequently can delay recovery and result in longer hospitalization.

Topics: Acute Disease; Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; Case-Control Studies; Ceftriaxone; Escherichia coli; Escherichia coli Infections; Female; Gene Expression; Humans; Length of Stay; Male; Microbial Sensitivity Tests; Middle Aged; Pyelonephritis; Retrospective Studies; Treatment Outcome

This study aimed to demonstrate if the addition of anti-inflammatory treatment to antibiotic therapy shows any superiority to the treatment with antibiotic only.. Forty-nine Wistar rats were divided into 7 groups. Pyelonephritis was performed by E. coli injection to upper pole of kidneys except control group. Group 2 was not treated. Ceftriaxone, ketoprofen, "ceftriaxone + ketoprofen," methylprednisolone, and "ceftriaxone + methylprednisolone" were given in the groups. The technetium-99m-dimercaptosuccinic acid scintigraphies were performed in 3rd day to detect pyelonephritis and 10th week to detect renal scarring. All kidneys were also histopathologically evaluated.. When 3rd day and 10th week scintigraphies were compared, initial 2.00 ± 0.30 point pyelonephritis score resulted in 0.71 ± 0.36 renal scar score in "ceftriaxone + ketoprofen" group (P = 0.039). Initial 2.00 ± 0.43 point pyelonephritis score resulted in 0.86 ± 0.26 renal scar score in "ceftriaxone + methylprednisolone" group (P = 0.041). Renal scar score was declined in "ceftriaxone + ketoprofen" group and "ceftriaxone + methylprednisolone" group compared with no-treatment group on 10th week of the study (P = 0.026, P = 0.044). On histopathological evaluation, it was seen that renal scar prevalence and expansion declined significantly in "ceftriaxone + ketoprofen and ceftriaxone + methylprednisolone" (P = 0.011, P = 0.023).. It was evidenced that ceftriaxone treatment in combination with ketoprofen or methylprednisolone declined scar formation in scintigraphic and histopathologic examinations of the kidneys.

Topics: Acute Disease; Animals; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Ceftriaxone; Cicatrix; Drug Therapy, Combination; Escherichia coli; Escherichia coli Infections; Ketoprofen; Methylprednisolone; Pyelonephritis; Radionuclide Imaging; Radiopharmaceuticals; Rats; Technetium Tc 99m Dimercaptosuccinic Acid

Urinary tract infections (UTIs) due to extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae in children are becoming more frequent, and they are commonly treated initially with a second- or third-generation cephalosporin. We developed a murine model of ascending UTI caused by ESBL-producing Escherichia coli. Using this model, we investigated the renal bacterial burden, interleukin-6 (IL-6) expression, and histopathological alterations caused by ESBL- and non-ESBL-producing bacteria after 1, 2, or 6 days with or without ceftriaxone therapy. The renal bacterial burden, IL-6 concentration, and histological inflammatory lesions were not significantly different between mice infected with ESBL- and non-ESBL-producing bacteria without treatment at any of the time points examined. Following ceftriaxone administration, the bacterial burden was eliminated in the kidneys of mice infected with ESBL- and non-ESBL-producing bacteria on the 6th postinfection day. The histological analysis demonstrated that among mice treated with ceftriaxone, those infected with ESBL-producing bacteria had more profound renal alterations than those infected with non-ESBL-producing bacteria on the 6th day (P < 0.001). In comparison, microbiological outcomes did not differ significantly between mice infected with ESBL- and non-ESBL-producing bacteria at any of the time points examined. The effectiveness of ceftriaxone in mice with UTIs due to ESBL-producing E. coli may have therapeutic implications; it is, however, hampered by limited activity on the histopathological lesions, a finding that needs further investigation.

Topics: Animals; Anti-Bacterial Agents; Bacterial Load; beta-Lactamases; Ceftriaxone; Disease Models, Animal; Escherichia coli; Escherichia coli Infections; Female; Gene Expression; Interleukin-6; Kidney; Mice; Mice, Inbred BALB C; Pyelonephritis; Treatment Outcome

Topics: Abdominal Abscess; Abdominal Pain; Aged; Anti-Bacterial Agents; Ceftriaxone; Combined Modality Therapy; Drainage; Emphysema; Female; Flank Pain; Gases; Humans; Klebsiella Infections; Pyelonephritis; Radiography, Abdominal; Rupture, Spontaneous; Tomography, X-Ray Computed

Topics: Adrenal Gland Neoplasms; Anti-Bacterial Agents; C-Reactive Protein; Ceftriaxone; Child; Diagnosis, Differential; Erythrocytes; Humans; Laparotomy; Leukocytes; Male; Mesenteric Cyst; Pancreatic Cyst; Pheochromocytoma; Pyelonephritis; Tomography, X-Ray Computed; Ultrasonography

Topics: Adult; Agranulocytosis; Anti-Bacterial Agents; Bone Marrow; Ceftriaxone; Fatal Outcome; Female; Humans; Mitral Valve Stenosis; Pregnancy; Pregnancy Complications, Cardiovascular; Puerperal Infection; Pulmonary Aspergillosis; Pyelonephritis

We describe a female patient with Alport disease who developed antiglomerular basement membrane nephritis late after kidney transplantation during the treatment of an acute bacterial pyelonephritis and discuss the potential role of the infection as a trigger for the development of this nephritis.

Topics: Adolescent; Anti-Bacterial Agents; Anti-Glomerular Basement Membrane Disease; Autoantibodies; Basement Membrane; Ceftriaxone; Drug Substitution; Escherichia coli Infections; Female; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Glomerulus; Kidney Transplantation; Nephritis, Hereditary; Plasmapheresis; Pulse Therapy, Drug; Pyelonephritis; Treatment Outcome

Myocarditis is defined clinically as inflammation of the heart muscle, which can be caused by infectious agents, toxins or immunologic reactions. Most recognized cases of acute myocarditis are secondary to cardiotropic viral infections. Escherichia coli rarely cause myocarditis. The authors report a 25-year-old woman with E coli-induced acute pyelonephritis and septic shock that was complicated with acute myocarditis. Her symptoms mimicked acute myocardial infarction. The authors discuss the possible mechanism of bacterial sepsis-induced myocarditis.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Electrocardiography; Escherichia coli Infections; False Positive Reactions; Female; Humans; Myocardial Infarction; Myocarditis; Pyelonephritis; Shock, Septic; Urinary Tract Infections

An 84-year-old woman under warfarin therapy, who had undergone mechanical valve replacement 29 months previously, developed coagulation abnormalities after antibiotic treatment for pyelonephritis. Laboratory findings included PT at 47.6 sec, activated thromboplastin time (APTT) at 147 sec, factor V (FV) activity of 4% and FV inhibitor of 8 BU. Although overt bleeding was not observed, administration of prednisolone was started. Her coagulation abnormalities were rapidly normalized. It was later determined that the patient had received bovine thrombin at surgery. The presence of a FV inhibitor should be considered in the differential diagnosis in patients demonstrating an unexpected prolongation of PT under warfarin therapy following surgery.

Topics: Aged, 80 and over; Animals; Anti-Bacterial Agents; Anticoagulants; Aortic Valve; Aortic Valve Stenosis; Cattle; Ceftriaxone; Factor V; Female; Heart Valve Prosthesis; Hemorrhagic Disorders; Humans; Immunosuppressive Agents; Partial Thromboplastin Time; Postoperative Complications; Prednisolone; Prothrombin Time; Pyelonephritis; Species Specificity; Thrombin; Warfarin

Tumor necrosis factor-alpha (TNF-alpha) is an important mediator of the inflammatory response in serious bacterial infections. The aim of this study was to evaluate the potential of urinary TNF-alpha for diagnosis of acute pyelonephritis in children.. This study was conducted from March 2006 to December 2007 on children with confirmed diagnosis of acute pyelonephritis. They all had positive renal scintigraphy scans for pyelonephritis and leukocyturia. The ratios of urinary TNF-alpha to urine creatinine level were determined and compared in patients before and after antibiotic therapy.. Eighty-two children (13 boys and 69 girls) with acute pyelonephritis were evaluated. The mean pretreatment ratio of urinary TNF-alpha to urinary creatinine level was higher than that 3 days after starting on empirical treatment (P = .03). The sensitivity of this parameter was 91% for diagnosis of acute pyelonephritis when compared with demercaptosuccinic acid renal scintigraphy as gold standard.. Based on our findings in children, the level of urinary TNF-alpha-creatinine ratio is acute increased in pyelonephritis and it decreases after appropriate therapy with a high sensitivity for early diagnosis of the disease. Further research is warranted for shedding light on the potential diagnostic role of urinary TNF-alpha in pyelonephritis in children.

Topics: Acute Disease; Anti-Bacterial Agents; Biomarkers; Ceftriaxone; Child, Preschool; Creatinine; Enzyme-Linked Immunosorbent Assay; Female; Humans; Infant; Infant, Newborn; Male; Pyelonephritis; Tumor Necrosis Factor-alpha

Cytokines play a major role in renal scar formation following febrile urinary tract infection (UTI). We investigated the role of dexamethasone combined with antibiotics in diminishing urinary interleukin-6 (UIL-6) and UIL-8 concentrations during the acute phase of pyelonephritis compared with standard antibiotic therapy. UIL-6 and UIL-8 concentrations were determined by enzyme immunoassay in 34 children with pyelonephritis who were treated with ceftriaxone plus dexamethasone (case group) and in 20 patients with the same diagnosis treated with ceftriaxone alone (control group). Urine samples were obtained at the time of presentation prior to drug administration and at follow-up 72 h after initiation of medication. Creatinine concentrations were also determined, and cytokine/creatinine ratios were calculated to standardize samples. Differences between cytokine/creatinine ratios in initial and follow-up urine samples were significant in the case group (P < 0.001) but not for controls. In addition, combined antibiotic and dexamethasone significantly decreased UIL-6 and UIL-8 concentrations compared with antibiotic alone (P < 0.05). We conclude that dexamethasone combined with antibiotics significantly decreases UIL-6 and UIL-8 levels in patients with acute pyelonephritis. This suggests that the clinical use of corticosteroids may prevent scar formation following febrile UTI.

Topics: Acute Disease; Ceftriaxone; Child; Child, Preschool; Cicatrix; Creatinine; Cytokines; Dexamethasone; Female; Humans; Infant; Interleukin-6; Interleukin-8; Leukocyte Count; Male; Pyelonephritis; Urinary Tract Infections; Vesico-Ureteral Reflux

Much controversy exists as to whether cephalosporin treatment is appropriate for infections caused by ESBL-producing organisms because no randomized controlled studies have been performed.. Evaluate the therapeutic outcomes of ceftriaxone treatment in acute pyelonephritis caused by ESBL-producing Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis.. The authors performed a prospective study in female patients hospitalized with acute pyelonephritis caused by ESBL-producing or ESBL-nonproducing E. coli, K. pneumoniae, or P. mirabilis in four hospitals in Thailand from 2004 to 2006. The clinical and microbiological outcomes were evaluated at 72 hours after empirical ceftriaxone treatment.. One hundred eleven patients with the mean age of 65.29 years participated in this study. There were no differences in demographic and clinical characteristics and laboratory data between the ESBL-producing and ESBL-nonproducing groups except the higher rates of previous antibiotic use and urinary tract infection; and the lower frequency of costovertebral angle tenderness in the ESBL-producing group. Both clinical (65% and 93%) and microbiological (67.5% and 100%) responses at 72 hours after ceftriaxone treatment were poorer in the ESBL-producing group than in the ESBL-nonproducing group (p < 0.0002).. To the authors' knowledge, this is the first prospective study to evaluate the outcomes of ceftriaxone treatment in acute pyelonephritis caused by ESBL-producing Enterobacteriaceae. The present study confirms that acute pyelonephritis in the female patients caused by ESBL-producing strains could not be treated with ceftriaxone.

Topics: Acute Disease; Aged; Anti-Bacterial Agents; beta-Lactamases; Case-Control Studies; Ceftriaxone; Disease Susceptibility; Drug Resistance, Multiple, Bacterial; Escherichia coli; Female; Humans; Klebsiella pneumoniae; Prospective Studies; Proteus mirabilis; Pyelonephritis

To examine the incidence, risk factors, microbial pathogens, and pregnancy outcomes of pregnant women with acute antepartum pyelonephritis.. Among all pregnant women admitted to Patan Hospital, Nepal from 14 April 2004 to 13 April 2005, pregnant women with acute pyelonephritis were retrospectively studied. Furthermore, the pregnancy outcomes of these women were compared with those of the general obstetric population received at our hospital during the same time period.. Of 7034 pregnant women delivered at our hospital, 94 cases of acute antepartum pyelonephritis were diagnosed during the study period (incidence: 1.3%). Maternal mean age for the infection was 22 +/- 3.41 years. Acute pyelonephritis was most frequently occurred in nulliparous women (75%), and in the second trimester (60%). Of 94 cases, 62 (65.95%) showed positive urine culture, with the predominating organism Escherichia coli in 81% (50 of 62) of cases. E. coli was found most sensitive to nitrofurantoin (82.1% of cases), followed by ceftriaxone (81.55% of cases), gentamicin (77.01% of cases), ofloxacin (60.57% of cases), and ciprofloxacin (59% of cases). The incidences of low-birthweight babies (14%) and preterm babies (7.81%) in the cases with acute antepartum pyelonephritis were not significantly different compared to that of all births in our hospital during the same period (13% and 8%, respectively; P > 0.05).. Acute pyelonephritis requiring admission to hospital most frequently occurs in nulliparous women, and in the second trimester. The predominating organism responsible for acute pyelonephritis is E. coli. Ceftriaxone, because of its safety and negligible side-effect, should be the drug of choice for acute antepartum pyelonephritis.

Topics: Acute Disease; Adult; Anti-Bacterial Agents; Ceftriaxone; Escherichia coli Infections; Female; Humans; Incidence; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature; Length of Stay; Nepal; Parity; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Pregnancy Outcome; Pregnancy Trimester, Second; Pyelonephritis; Retrospective Studies; Risk Factors

To describe the different modalities of ambulatory management of acute pyelonephritis in patients older than 3 months of age in paediatric emergency units of the Ile de France region in 2004.. Between October 2003 and April 2004, referents of 39 paediatric emergency units of the Ile de France region were questioned through a written questionnaire concerning the management of acute pyelonephritis: in or outpatient modalities, antibiotic regimen (molecule and route of administration), investigations and follow-up.. Thirty-one questionnaires (79.5%) were returned and analysed. A written protocol was available in 60% of the units. Outpatient management was performed in 24/31 centres. Young age, poor clinical tolerance, urological abnormalities and social difficulties were the major contra-indications for such management. Ultrasonic echography at diagnosis (within 24 h) was performed in 50% of the units. Antibiotics were started using IV route in 18/24 units (75%) and ceftriaxone and aminoside were respectively prescribed in 100% and 29.4% of the units for a duration of 1 to 5 days before switching to the oral route. Antibiotherapy was started orally in 6 units and cefixime was chosen by 5 of them. Follow-up consultations were scheduled in 100% of the units but with various delay after initiation of the treatment. The total duration of treatment was mostly 10 days and oral prophylactic antibiotherapy was prescribed by 10/24 centres after completion of the treatment. Cystoureterography was systematically realized by 83.3% of the units.. Despite important differences in the management of acute pyelonephritis in Ile-de-France, a majority of the units follows similar therapeutic modalities. In the absence of consensus, new recommendations are necessary concerning the management of pyelonephritis in infants and children in France.

Topics: Acute Disease; Administration, Oral; Adolescent; Age Factors; Anti-Bacterial Agents; Cefaclor; Cefixime; Ceftriaxone; Child; Child, Preschool; Data Collection; Drug Therapy, Combination; Emergency Service, Hospital; Follow-Up Studies; France; Humans; Infant; Infusions, Parenteral; Injections, Intravenous; Intensive Care Units, Pediatric; Outpatients; Pyelonephritis; Surveys and Questionnaires; Time Factors; Trimethoprim, Sulfamethoxazole Drug Combination; Ultrasonography; Urethra; Urinary Bladder; Urography

Emphysematous pyelonephritis is characterized by infection and gas formation in the renal parenchyma. This rare disorder tends to occur more frequently in patients with diabetes mellitus and urinary tract obstruction. In this case report, we describe a nondiabetic patient with Hinman syndrome who developed recurrent emphysematous pyelonephritis that was successfully treated with antibiotics on both occasions.

Topics: Anti-Bacterial Agents; Ceftriaxone; Emphysema; Escherichia coli Infections; Humans; Male; Middle Aged; Pyelonephritis; Recurrence; Remission Induction

To determine the effects of melatonin combined with antibiotic administration on the suppression of renal scarring in an experimental pyelonephritis model.. The control group underwent a sham operation without infection. In the other groups, treatment began 72 hours after direct bacterial inoculation. In the no-treatment group, rats received daily intraperitoneal injections of saline. In the antibiotic-only group, the rats were treated only with ceftriaxone intramuscularly at a dose of 50 mg/kg once daily for 5 days. In the melatonin-only group, only 20 mg/kg of melatonin once daily was given by intraperitoneal injection for 5 days. In the antibiotic plus melatonin group, melatonin and ceftriaxone were administered at the same dosages and duration as for the single-modality treatment groups. After 6 weeks, the kidneys were removed for malondialdehyde measurements and histopathologic examination (inflammatory response and cicatrization).. Melatonin only (134.25 +/- 13.42) and antibiotic plus melatonin treatment (122.62 +/- 8.91) caused a marked reduction in the mean malondialdehyde values compared with no treatment (214.12 +/- 17.77) and antibiotic-only treatment (161.37 +/- 16.03), with no significant difference compared with that of the control group (120.75 +/- 9.83). Histopathologically, in the no-treatment group, the severity of scarring correlated directly with the severity of inflammation (r = 0.93). No significant differences were found in the renal scarring scores in rats receiving no treatment and those treated only with antibiotic or melatonin. In the antibiotic plus melatonin treatment group, the cicatrization score was not statistically different from that of the control group.. When combined with antibiotics, melatonin causes a significant inhibition of malondialdehyde production and neutrophil infiltration caused by acute pyelonephritis in an experimental rat model, and these are responsible for the protective effect of melatonin against renal damage, preventing renal scarring formation.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Cicatrix; Disease Models, Animal; Drug Therapy, Combination; Kidney Diseases; Male; Melatonin; Pyelonephritis; Rats; Rats, Sprague-Dawley

Topics: Acute Disease; Anti-Bacterial Agents; Ceftriaxone; Child; Escherichia coli Infections; Humans; Kidney; Kidney Calculi; Male; Pyelonephritis; Ultrasonography

The evolution and the relationship between inflammatory and renal-injury markers in women with acute uncomplicated pyelonephritis under antimicrobial therapy were investigated in a prospective study. Markers were measured before and 6 and 24 h after the intravenous administration of 1 g of ceftriaxone. Before treatment, the median levels of all markers except the serum creatinine levels were high. Twenty-four hours after the onset of antibiotic treatment, the C-reactive protein (CRP) level continued to be high, while the serum interleukin-6 (IL-6) levels and the urine IL-6, IL-8, albumin, and immunoglobulin G (IgG) levels decreased significantly. In contrast, serum creatinine and tumor necrosis factor alpha levels and urine N-acetyl-beta-glucosaminidase, alpha1-microglobulin, and beta2-microglobulin levels did not change over time. There was a significant correlation between IL-6 and IL-8 levels and urine albumin and IgG levels (urine albumin and IgG levels are glomerular and urinary tract-injury markers) as well as between serum CRP levels and the levels of the tubular-injury markers. In women with acute pyelonephritis, appropriate antibiotic treatment rapidly decreases serum IL-6 levels and urine IL-6 and IL-8 levels, which correlate well with urine albumin and IgG levels.

Topics: Acute Disease; Adult; Aged; Anti-Bacterial Agents; Biomarkers; C-Reactive Protein; Ceftriaxone; Escherichia coli Infections; Female; Humans; Immunoglobulin G; Inflammation Mediators; Interleukin-6; Interleukin-8; Kidney; Middle Aged; Prospective Studies; Pyelonephritis

The aim of the current investigation was to evaluate practical impact of modern NCCLS recommendations for the selection of 2nd and 3rd generation cephalosporins in Moscow teaching multi profile hospital. The sensitivity of clinically significant 96 strains from patients with pyelonephritis and 180 strains from patients with lower respiratory tract infections (pneumonia, COPD) was compared for cefuroxime and cefotaxime or ceftriaxone according NCCLS recommendations during 2000-2001 years. At the lower respiratory tract infection total sensitivity of all pathogens was 70.6% and 72.8%, at the pyelonephritis 71.9% and 76.0% for 2nd and 3rd generations respectively. The differences between cephalosporins were not statistically significant. Based on the application of modern NCCLS recommendations in the routine microbiological practice similar clinical efficacy of 2nd and 3rd generations cephalosporin in lower respiratory tract infections and pyelonephritis could be predicted.

Topics: Anti-Bacterial Agents; Bronchitis; Cefotaxime; Ceftriaxone; Cefuroxime; Gram-Negative Bacteria; Hospitals, General; Hospitals, Teaching; Humans; Microbial Sensitivity Tests; Moscow; Pneumonia, Bacterial; Practice Guidelines as Topic; Pyelonephritis; Staphylococcus aureus

Topics: Acute Disease; Ceftriaxone; Cephalosporins; Child; Humans; Pyelonephritis; Urinary Tract Infections

The prolonged biological half-life of Ceftriaxone, allowing once-daily dosing, has contributed to the large diffusion of this third-generation cephalosporin in children. Ceftriaxone is known to induce reversible precipitates in the gallbladder of adults and children. A prospective study was conducted during 1997 in 34 children admitted for the treatment of acute pyelonephritis. Ceftriaxone (intravenous daily single-dose of 50 mg/kg under 2g/day) was initially used. A first gallbladder sonogram, performed before the first or second injection, was normal in all cases. A second evaluation was performed before the fifth and last injection. On this second evaluation the presence of one (n = 3) or two gallstones was recorded in 5 children (15%) on a sonogram made after 3 (n = 4) or 5 (n = 1) injections. Their median age was 7 years (range 4 months to 11 years). All five children remained symptom-free and the normalization of the sonographic patterns was constant on the last sonogram performed 2 (n = 1), 3 (n = 2) and 5 months (n = 2) after discontinuation of Ceftriaxone. This study confirms the possibility of precocious biliary lithiasis under Ceftriaxone therapy in childhood and their spontaneous dissolution after discontinuation of the drug. They seem unpredictable and independent of the age, sex in a cohort homogeneous for the nature of the infection, modality of a short- and low-dose therapy. Clinicians and radiologists should be aware of this complication as an etiology of a so-called primary cholelithiasis and to prevent anxiety or unnecessary cholecystectomy. The antibacterial and pharmacokinetic benefits of Ceftriaxone outweigh the problem of reversible biliary pseudolithiasis with this drug.

Topics: Acute Disease; Ceftriaxone; Child; Child, Preschool; Cholelithiasis; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Infant; Infusions, Intravenous; Male; Prospective Studies; Pyelonephritis; Risk Factors; Ultrasonography

Topics: Ceftriaxone; Cephalosporins; Child; Cholelithiasis; Escherichia coli Infections; Female; Humans; Pyelonephritis; Risk Factors; Time Factors

Topics: Aged; Ceftriaxone; Drainage; Emphysema; Female; Humans; Middle Aged; Nephrectomy; Pyelonephritis

To study postpartum distribution and protein binding of ceftriaxone (CTX) between maternal blood and milk and to discuss risk factors and possible impact for the neonate.. Reference articles and books are identified in the text.. CTX distribution and protein binding between maternal blood and milk postpartum were studied in a patient at term presenting with acute pyelonephritis caused by Escherichia coli. The antibiotic therapy prescribed pending bacteriology results consisted of CTX 2 g/d, ornidazole 1 g/d, and tobramycin 3 mg/kg/d. Pharmacokinetics of total CTX were studied after the first 2-g infusion. At plateau (i.e., two days after delivery; seventh infusion), pharmacokinetics and milk distribution of total and free CTX also were studied. No accumulation of CTX was noted in the plasma at plateau. When high dosages of CTX are used (approximately 2 g), its penetration into the milk is important (i.e., protein binding capacity is overwhelmed). No notable adverse reactions occurred in mother or child. Thus, an important diffusion into the milk (4.4 percent of the dose) appears not to be clinically important. Our knowledge of both metabolism and milk distribution of drugs with high protein binding (> or = 95 percent) and an acid characteristic should be expanded to better understand their use during both the pregnancy and postpartum periods. Finally, the child of the patient described here has normal initial growth and development at the present time.. Caution should be taken when drugs such as CTX, which have both high protein binding (> or = 95 percent) and an acid characteristic are administered to breastfeeding women. Drugs of this type should be systematically investigated to better understand their use during pregnancy and postpartum.

Topics: Adult; Blood Proteins; Ceftriaxone; Escherichia coli Infections; Female; France; Humans; Infant, Newborn; Male; Milk, Human; Postpartum Period; Pregnancy; Pregnancy Complications, Infectious; Protein Binding; Pyelonephritis; Risk Factors

Ceftriaxone, a broad-spectrum third-generation cephalosporin with a long half-life, was administered intramuscularly to 23 outpatients who had a variety of infectious diseases. Cure was achieved in 21 of the patients (91%). The results of this study indicate that ceftriaxone is an effective and well-tolerated antimicrobial agent when administered intramuscularly to outpatients with various infections.

Topics: Adult; Aged; Bacterial Infections; Ceftriaxone; Escherichia coli; Female; Humans; Injections, Intramuscular; Male; Middle Aged; Pneumonia; Pyelonephritis; Skin Diseases, Infectious; Staphylococcus aureus; Streptococcus

Selected patients with community-acquired infections can be discharged from the hospital, when afebrile and stable, with parenteral antibiotic therapy continued on an ambulatory basis. This therapy is currently possible because of the availability of long-acting cephalosporins that can be administered once daily, often with substantial reductions in hospital costs. Cefonicid and ceftriaxone both have sufficiently long half-lives and either may be administered intramuscularly once daily. Their antibacterial spectra encompass many of the pathogens encountered in community-acquired infections of the lower respiratory tract, skin and soft tissue, bone, and urinary tract. Ceftriaxone, a third-generation cephalosporin, has a broader spectrum than the second-generation agent cefonicid. Ceftriaxone should generally be reserved for the treatment of gonococcal disease and of community- or hospital-acquired infections due to organisms resistant to the narrower-spectrum and less expensive long half-life agent cefonicid.

Topics: Ambulatory Care; Cefamandole; Cefonicid; Ceftriaxone; Costs and Cost Analysis; Humans; Osteomyelitis; Pneumonia; Pyelonephritis; Skin Diseases, Infectious

Unilateral acute pyelonephritis were produced in rabbits by injecting E. coli, using the retrograde route and after a temporary ureteral obstruction. Animals were treated with ceftriaxone IM at a dose of 50 mg/kg/d and 100 mg/kg/d (corresponding to 1 g/d and 2 g/d in humans) either by a single daily injection or by two daily injections at 12th intervals. Sacrifices were performed at day 5 and 7 of therapy. Analysis of bacteriological, morphological and histological data obtained in infected kidneys demonstrates that the single daily injection of ceftriaxone is more effective than the same dose divided in two injections at 12 h intervals. These results are observed as well with low and high doses of ceftriaxone.

Topics: Acute Disease; Animals; Ceftriaxone; Escherichia coli Infections; Evaluation Studies as Topic; Male; Pyelonephritis; Rabbits

Cefonicid (Monocid) and ceftriaxone (Rocephin) are long half-life cephalosporins that may be used for serious infections in the outpatient setting. They may be used as an extension of initial hospital treatment, or therapy can be initiated and completed in many cases with the patient remaining at home. Sufficient clinical experience exists with both ceftriaxone and cefonicid to recommend these agents for selected patients having pyelonephritis, osteomyelitis, or soft tissue infections. Cefonicid, perhaps in combination with erythromycin, will provide excellent coverage for complicated community-acquired pneumonias. Ceftriaxone is effective as single-dose therapy for even complicated gonococcal infections. The use of long half-life cephalosporins in ambulatory practice may result in substantial cost savings for certain patients.

Topics: Ambulatory Care; Bacterial Infections; Cefamandole; Cefonicid; Ceftriaxone; Cellulitis; Cephalosporins; Gonorrhea; Half-Life; Humans; Injections, Intramuscular; Osteomyelitis; Pyelonephritis; Respiratory Tract Infections; Staphylococcal Infections; Streptococcal Infections

An acute exudative Escherichia coli pyelonephritis rat model was used to study the influence of progressive pyelonephritis on the efficacy of antibiotic treatment. In this model, transient ureteral obstruction after E. coli bladder inoculation induces early bacterial multiplication in the kidney parenchyma, and the bacterial counts peak by 48 h. The inflammatory response (assessed by the increase in kidney weight) is somewhat delayed, starting 36 h after inoculation and peaking by 72 h. Groups of rats received 4 doses over 48 h of saline, ceftriaxone (100 mg/kg), or ceftriaxone (100 mg/kg) plus gentamicin (4 mg/kg). These treatments were initiated 24, 36, 48, or 72 h after bladder inoculation. Antibiotic treatment started at 24 h was significantly more effective in reducing bacterial counts in the kidney parenchyma than at any later therapy onset. Only when started 24 h after inoculation was the synergistic combination of ceftriaxone plus gentamicin more effective in reducing bacterial counts than ceftriaxone alone. Ceftriaxone and ceftriaxone plus gentamicin regimens started at 24 h reduced significantly (by 42 and 55%, respectively) the incidence of acute exudative pyelonephritis when compared with the incidence in saline-treated controls. Early therapy onset (24 h) strikingly reduced the development of the inflammatory response. This reduction was less marked when antibiotic therapy was started at 36 h and no longer apparent when therapy onset was delayed up to 48 or 72 h. In conclusion, the efficacy of antibiotics in eradicating bacteria from the kidney parenchyma and in preventing acute exudative pyelonephritis was markedly hampered by the development of pyelonephritis.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Escherichia coli Infections; Exudates and Transudates; Gentamicins; Male; Pyelonephritis; Rats; Rats, Inbred Strains; Time Factors

We have tested the effectiveness of several antibiotic regimens, using a rat model of Escherichia coli experimental pyelonephritis that mimics the conditions of severe renal infections in man because the infection is acquired by the ascending route. We found that ceftriaxone, when given for 5 days to rats with severe exudative pyelonephritis, was as effective as the combination ceftriaxone + gentamicin or the reference combination ampicillin + gentamicin. This effectiveness in vivo of the antibiotic alone was achieved despite a marked synergism between the combinations of antibiotics in vitro. This observation suggests that a new and extremely active cephalosporin is as effective in vivo when used alone as when given in combination with an aminoglucoside and provides rationale for testing the use of single antibiotic therapy for clinical situations for which combinations of antibiotics are currently recommended.

Topics: Ampicillin; Animals; Anti-Bacterial Agents; Cefotaxime; Ceftriaxone; Drug Therapy, Combination; Escherichia coli Infections; Gentamicins; Kidney; Male; Pyelonephritis; Rats; Rats, Inbred Strains