Luca Erba1, Ludovico Furlan2, Alice Monti2, Elisa Marsala2, Giulia Cernuschi3, Monica Solbiati3, Christian Bracco4, Giulia Bandini5, Monica Pecorino Meli6, Giovanni Casazza7, Nicola Montano8,9, Rodolfo Sbrojavacca10, Giorgio Costantino3,9. 1. Università Degli Studi Di Milano, Milan, Italy. luca.erba@unimi.it. 2. Università Degli Studi Di Milano, Milan, Italy. 3. UOC Pronto Soccorso E Medicina D'Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. 4. Department of Internal Medicine, Santa Croce and Carle General Hospital, Cuneo, Italy. 5. Medicina Interna, Università Degli Studi Di Firenze, AOU Careggi, Firenze, Italy. 6. Dipartimento Delle Professioni Sanitarie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. 7. Dipartimento Di Scienze Biomediche E Cliniche "L. Sacco", Università Degli Studi Di Milano, Milan, Italy. 8. Dipartimento Di Medicina Interna, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy. 9. Dipartimento Di Scienze Cliniche E Di Comunità, Università Degli Studi Di Milano, Milan, Italy. 10. Dipartimento Di Pronto Soccorso E Medicina D'Urgenza, Azienda Ospedaliera Universitaria Di Udine, Udine, Italy.
Abstract
BACKGROUND: The Italian Society of Internal Medicine (SIMI) Choosing Wisely Campaign has recently proposed, among its five items, to reduce the prescription of long-term intravenous antibiotics if not indicated. The aim of our study was to assess the available evidences on optimal duration of antibiotic treatment in pyelonephritis through a systematic review of secondary studies. MATERIALS AND METHODS: We searched for all guidelines on pyelonephritis and systematic reviews assessing the optimal duration of antibiotic therapy in this type of infection. We compared the recommendations of the three most cited and recent guidelines on the topic of interest. We extracted data of non-duplicated RCT from the selected systematic reviews and performed meta-analyses for clinical and microbiological failure. A trial sequential analysis (TSA) was also achieved to identify the need for further evidence. RESULTS: We identified 4 systematic reviews, including data from 10 non-duplicated RCTs (1536 patients). The meta-analysis showed a higher rate of clinical cure for short-course antibiotic treatment (RR for clinical failure 0.70, 95% CI [0.53-0.94]). No significant difference in the rate of microbiological failure (RR 1.06, 95% CI [0.75-1.49]) was observed. In terms of clinical cure, the TSA suggests that current evidence is sufficient to consider short course at least as effective as long-course treatment. Selected guidelines recommend considering shorter courses, but do not cite most of the published RCTs. CONCLUSIONS: Short-course antibiotic treatment is at least as effective as longer courses for both microbiological and clinical success in the treatment of acute uncomplicated pyelonephritis.
BACKGROUND: The Italian Society of Internal Medicine (SIMI) Choosing Wisely Campaign has recently proposed, among its five items, to reduce the prescription of long-term intravenous antibiotics if not indicated. The aim of our study was to assess the available evidences on optimal duration of antibiotic treatment in pyelonephritis through a systematic review of secondary studies. MATERIALS AND METHODS: We searched for all guidelines on pyelonephritis and systematic reviews assessing the optimal duration of antibiotic therapy in this type of infection. We compared the recommendations of the three most cited and recent guidelines on the topic of interest. We extracted data of non-duplicated RCT from the selected systematic reviews and performed meta-analyses for clinical and microbiological failure. A trial sequential analysis (TSA) was also achieved to identify the need for further evidence. RESULTS: We identified 4 systematic reviews, including data from 10 non-duplicated RCTs (1536 patients). The meta-analysis showed a higher rate of clinical cure for short-course antibiotic treatment (RR for clinical failure 0.70, 95% CI [0.53-0.94]). No significant difference in the rate of microbiological failure (RR 1.06, 95% CI [0.75-1.49]) was observed. In terms of clinical cure, the TSA suggests that current evidence is sufficient to consider short course at least as effective as long-course treatment. Selected guidelines recommend considering shorter courses, but do not cite most of the published RCTs. CONCLUSIONS: Short-course antibiotic treatment is at least as effective as longer courses for both microbiological and clinical success in the treatment of acute uncomplicated pyelonephritis.
Authors: Gordon H Guyatt; Andrew D Oxman; Gunn E Vist; Regina Kunz; Yngve Falck-Ytter; Pablo Alonso-Coello; Holger J Schünemann Journal: BMJ Date: 2008-04-26
Authors: Shelley S Magill; Jonathan R Edwards; Zintars G Beldavs; Ghinwa Dumyati; Sarah J Janelle; Marion A Kainer; Ruth Lynfield; Joelle Nadle; Melinda M Neuhauser; Susan M Ray; Katherine Richards; Richard Rodriguez; Deborah L Thompson; Scott K Fridkin Journal: JAMA Date: 2014-10-08 Impact factor: 56.272
Authors: Greta Falavigna; Giorgio Costantino; Raffaello Furlan; James V Quinn; Andrea Ungar; Roberto Ippoliti Journal: Intern Emerg Med Date: 2018-10-23 Impact factor: 3.397