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 acute uncomplicated pyelonephritis
33 age
34 analysis
35 antibiotic treatment
36 antimicrobial resistance
37 arm
38 bacterium
39 blood cultures
40 clinical cure rate
41 clinical signs
42 coli
43 criteria
44 culture
45 cure
46 cure rate
47 day 10
48 day 30
49 days
50 days of treatment
51 debate
52 deviation age
53 duration
54 efficacy
55 end
56 end of treatment
57 female patients
58 fever
59 fluoroquinolone treatment
60 fluoroquinolones
61 inclusion criteria
62 infection
63 main bacterium
64 means
65 microbiological cure rates
66 oral fluoroquinolones
67 outcomes
68 patients
69 positive blood cultures
70 positive urinalysis
71 pyelonephritis
72 randomization
73 rate
74 resistance
75 signs
76 standard deviation age
77 temperature
78 tract infections
79 treatment
80 treatment duration
81 trials
82 uncomplicated pyelonephritis
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