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Systematic review with meta analysis
The evidence for treating acute pyelonephritis with oral antibiotic therapy and short intravenous treatment is growing for low-risk children
  1. Arnaud Merglen1,2,
  2. Sanjay Mahant1,3
  1. 1Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada;
  2. 2Department of Pediatrics, University of Geneva, Switzerland;
  3. 3SickKids Research Institute and Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
  1. Correspondence to : Dr Arnaud Merglen, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada M5G 1X8; arnaud.merglen{at}

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Many children experience at least one urinary tract infection (UTI). Acute pyelonephritis is the severe presentation of a UTI with systemic features. It is associated with an increased risk of septic shock and bacteraemia, particularly among infants. This systematic review aimed to provide the best current evidence for choosing antibiotic therapy for acute pyelonephritis in children. Several aspects of therapy were considered including different: antibiotics, dosing regimens of the same antibiotic, treatment duration and routes of administration.


This updated Cochrane review included studies that assessed antibiotic therapy for bacterially proven UTI with acute pyelonephritis in children (<18 years of age). Studies including patients with previously diagnosed UTI or urinary tract abnormalities were considered eligible.

Predetermined short-term outcomes were fever duration, persistent symptoms or inflammatory markers at …

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.