K-1484. Early Switch to Oral Versus Intravenous Antimicrobial Treatment for Hospitalized Patients with Acute Pyelonephritis: A Systematic Review of Randomized Controlled Trials
Session: Poster Session: Urinary Tract Infections
Sunday, October 26, 2008: 12:00 AM
Room: Hall C
Background: Acute pyelonephritis is a common infection that causes significant morbidity and mortality, particularly in pediatric populations. Early switch strategies (from intravenous to per os treatment) may be an acceptable or even preferred option in the treatment of patients with acute pyelonephritis. We sought to evaluate the effectiveness and safety of early switch strategies in hospitalized patients of any age with acute pyelonephritis. Methods: In order to find randomized controlled trials (RCTs) that compared intravenous antibiotic regimens with those including an early switch to oral after initial intravenous treatment, we searched PubMed, Cochrane Central Register of Controlled Trials and Scopus. Results: Seven individual RCTs were regarded as eligible for inclusion in our review. In 4 RCTs the intravenous treatment arms were not switched to oral treatment until the end of the study; in the remaining 3, the intravenous treatment arms were switched late to oral treatment (after x days of intravenous treatment). These treatment arms were compared with patients in whom an early switch to oral treatment occurred (after 1-3 days of intravenous treatment). Data regarding the incidence of renal scars, microbiological eradication, clinical success, reinfection, persistence of acute pyelonephritis, and adverse events were provided in 4, 5, 3, 5, 3, and 4 RCTs, respectively. There were no differences regarding the above outcomes between the two compared treatment regimens.
Conclusion: Early switch to oral antibiotic strategies seem to be equally effective and safe to intravenous regimens for the treatment of hospitalized patients with acute pyelonephritis.
Evridiki Vouloumanou, MD1, Maria Kazantzi, MD2, Matthew Falagas, MD, MSc, DSc2, Petros Rafailidis, MD, MSc, MRCP UK2 and  M. E. Falagas, None., (1)Alfa Institute of Biomedical Sciences (AIBS), (2)Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece


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