One or Three Weeks' Treatment of Acute Pyelonephritis?: A Double‐blind Comparison, Using a Fixed Combination of Pivampicillin Plus Pivmecillinam

Abstract

The clinical and bacteriological effects of 1 and 3 weeks' pivampicillin plus pivmecillinam treatment were compared in a double‐blind, randomized study of patients with acute pyelonephritis. Three weeks after the end of active treatment, clinical success was seen in 29 (91 %) of the 32 patients on 1‐week treatment, compared with 28 (97%) of the 29 patients treated for 3 weeks. Bacteriological success was seen in only nine (28%) patients in the 1‐week group vs. 20 (69%) in the 3‐week group (p=0.004). This difference was mainly due to a large number of relapses of lower urinary tract infection in the 1‐week group. Even in uncomplicated cases, the bacteriological result of the 1‐week treatment was unsatisfactory. Side‐effects were more common in the 3‐week treatment group. In conclusion, 1‐week treatment of patients with acute pyelonephritis is too short. Three weeks' treatment is effective in uncomplicated cases, but even longer treatment or low‐dose prophylaxis is indicated in certain patients with predisposing factors.