Table 1

Main evidence summary

CitationStudy groupStudy type (level of evidence)OutcomeKey resultComments
Hoberman et al 12 306 febrile children aged 1–24 months (4% <2 months, 47% <6 months).
Compared oral (cefixime) versus IV antibiotics as initial treatment.
Randomised controlled trial
(2)
Duration of fever24.7 hours (oral) vs 23.9 hours (IV), p=0.76Children <24 months with pyelonephritis treated with oral antibiotics have similar time to recovery and renal scarring.
Reinfection4.6% (oral) vs 7.2% (IV), p=0.28
Renal scarring on DMSA at 6 months9.8% (oral) vs 7.2% (IV), p=0.21
Montini et al 13 502 children aged 1 month–7 years with pyelonephritis (37% <6 months).
Compared oral (co-amoxiclav) versus IV antibiotics as initial treatment.
Randomised controlled trial
(2)
Duration of fever37 hours (oral) vs 34 hours (IV), mean difference −0.9 to 6.0Oral antibiotics are effective for treatment of pyelonephritis, with similar results for children aged <2 years and >2 years.
Renal scarring on DMSA at 12 months13.7% (oral) vs 17.7% (IV), mean difference −11.1% to 3.1%
Bocquet et al 15 171 children aged 1–36 months with acute pyelonephritis (12% <3 months).
Compared oral (cefixime) versus IV antibiotics as initial treatment.
Randomised controlled trial
(2)
Duration of fever24 hours (oral) vs 24 hours (IV)First-line oral cefixime is non-inferior to IV treatment in children under 3 years, and does not result in increased renal scarring in those younger than 3 months.
Renal scarring on DMSA (age <1 year)32% (oral) vs 33% (IV)
Renal scarring on DMSA (age <3 months)0% (oral) vs 2% (IV)
Strohmeier et al 14 Children aged 0–18 years with acute pyelonephritis.
Comparison of oral antibiotics with IV then oral antibiotics (total 10–14 days).
Systematic review with meta-analysis of randomised and quasi-randomised trials
(1)
Duration of feverMean difference 2.05 hours longer with oral (−0.84 to 4.94)
Moderate quality
Initial oral therapy was equivalent to sequential IV to oral therapy for UTI in children aged 0–18 years.
Renal scarring on DMSA at 6–12 monthsRR 0.82 (0.59–1.12)
Moderate quality
  • DMSA, dimercaptosuccinic acid scintigraphy; IV, intravenous; RR, risk ratio; UTI, urinary tract infection.