Is 5 days of oral fluoroquinolone enough for acute uncomplicated pyelonephritis? The DTP randomized trial View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2017-03-10

AUTHORS

A. Dinh, B. Davido, M. Etienne, F. Bouchand, A. Raynaud-Lambinet, E. Aslangul-Castier, T. A. Szwebel, C. Duran, G. Der Sahakian, C. Jordy, X. Ranchoux, N. Sembach, E. Mathieu, A. Davido, J. Salomon, L. Bernard

ABSTRACT

The treatment duration of acute uncomplicated pyelonephritis (AUP) is still under debate. As shortening treatment duration could be a means to reduce antimicrobial resistance, we aimed to establish whether 5 days of antibiotic treatment is non-inferior to 10 days in patients with AUP. We performed an open-label prospective randomized trial comparing 5 days to 10 days of fluoroquinolone treatment for AUP. The inclusion criteria were: female patients aged ≥18 years with clinical signs of urinary tract infection, fever >38 °C, and positive urinalysis. Patients were randomized to either 5 or 10 days of fluoroquinolone treatment. Outcome was cure at day 10 and day 30 after the end of treatment. One hundred patients were randomized and 12 were excluded after randomization. The mean ± standard deviation (SD) age was 31.8 ± 11 years old and the mean ± SD temperature was 38.6 ± 0.7 °C. The main bacterium involved was Escherichia coli (n = 86; 97.7%) and 3 (3.4%) patients had a positive blood culture. In the post-hoc analysis, clinical cure 10 days after the end of the treatment was 28/30 (93.3%) in the 5-day arm and 36/38 (94.7%) in the 10-day arm (p = 1.00). At day 30, the clinical cure rate was 23/23 (100%) in the 5-day arm and 20/20 (100%) in the 10-day arm (p = 1.00). The microbiological cure rate was 20/23 (87.0%) in the 5-day arm and 16/20 (80.0%) in the 10-day arm (p = 1.00). The efficacy of 5 days of fluoroquinolone treatment does not seem different from 10 days of treatment for AUP. More... »

PAGES

1443-1448

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s10096-017-2951-6

DOI

http://dx.doi.org/10.1007/s10096-017-2951-6

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1084023840

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/28283830


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23 schema:description The treatment duration of acute uncomplicated pyelonephritis (AUP) is still under debate. As shortening treatment duration could be a means to reduce antimicrobial resistance, we aimed to establish whether 5 days of antibiotic treatment is non-inferior to 10 days in patients with AUP. We performed an open-label prospective randomized trial comparing 5 days to 10 days of fluoroquinolone treatment for AUP. The inclusion criteria were: female patients aged ≥18 years with clinical signs of urinary tract infection, fever >38 °C, and positive urinalysis. Patients were randomized to either 5 or 10 days of fluoroquinolone treatment. Outcome was cure at day 10 and day 30 after the end of treatment. One hundred patients were randomized and 12 were excluded after randomization. The mean ± standard deviation (SD) age was 31.8 ± 11 years old and the mean ± SD temperature was 38.6 ± 0.7 °C. The main bacterium involved was Escherichia coli (n = 86; 97.7%) and 3 (3.4%) patients had a positive blood culture. In the post-hoc analysis, clinical cure 10 days after the end of the treatment was 28/30 (93.3%) in the 5-day arm and 36/38 (94.7%) in the 10-day arm (p = 1.00). At day 30, the clinical cure rate was 23/23 (100%) in the 5-day arm and 20/20 (100%) in the 10-day arm (p = 1.00). The microbiological cure rate was 20/23 (87.0%) in the 5-day arm and 16/20 (80.0%) in the 10-day arm (p = 1.00). The efficacy of 5 days of fluoroquinolone treatment does not seem different from 10 days of treatment for AUP.
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31 Escherichia coli
32 SD temperature
33 acute uncomplicated pyelonephritis
34 age
35 analysis
36 antibiotic treatment
37 antimicrobial resistance
38 arm
39 bacterium
40 blood cultures
41 clinical cure 10
42 clinical cure rate
43 clinical signs
44 coli
45 criteria
46 culture
47 cure
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49 cure rate
50 day 10
51 day 30
52 days
53 days of treatment
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58 end
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60 female patients
61 fever
62 fluoroquinolone treatment
63 fluoroquinolones
64 inclusion criteria
65 infection
66 main bacterium
67 means
68 microbiological cure rates
69 oral fluoroquinolones
70 outcomes
71 patients
72 positive blood cultures
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74 pyelonephritis
75 randomization
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77 resistance
78 signs
79 standard deviation age
80 temperature
81 tract infections
82 treatment
83 treatment duration
84 trials
85 uncomplicated pyelonephritis
86 urinalysis
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