Children with acute pyelonephritis need medical re‐evaluation when home‐treated with oral antibiotics

Aim To investigate the efficacy and safety of home-treatment with oral piv-mecillinam or amoxicillin-clavulanate in children acute pyelonephritis. Methods Children aged over 6 months diagnosed culture confirmed pyelonephritis at Danish Paediatric Departments were home-treated (tablets) (liquid tablets). Follow-up was performed by phone (second treatment day) clinical review patients hospital (day three). Results Four hundred eighteen included. In total, 333/418 (80%) responded well to initial antibiotic treatment. 85/418 (20%) changed another these 47/418 (11%) a second-line 38/418 (9%) intravenous antibiotics due insufficient improvement bacterial resistance. Bacterial resistance similar for amoxicillin-clavulanate: 4/74 (5%) versus 33/333 (10%) (p = 0.22). Insufficient improvement, despite no resistance, primarily occurred treated piv-mecillinam: 16/74 (22%) 28/344 (8%) < 0.001), predominantly <5 years: 7/20 (35%) 9/54 (17%) 0.05), potentially because problems tablets. study population cases death septicemia developed after start Conclusion A regime >6 is safe; however, during treatment, re-evaluation required as 20% change necessary.