{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:29:45Z","timestamp":1790602185706,"version":"4.1.0"},"reference-count":46,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,3,1]]},"abstract":"<jats:p>OBJECTIVE. We report a prospective, randomized, multicenter trial that compared the effect of 3 vs 8 days of intravenous ceftriaxone treatment on the incidence of renal scarring at 6 to 9 months of follow-up in 383 children with a first episode of acute pyelonephritis.<\/jats:p>\n                  <jats:p>METHODS. After initial treatment with intravenous netilmicin and ceftriaxone, patients were randomly assigned to either 5 days of oral antibiotics (short intravenous treatment) or 5 days of intravenous ceftriaxone (long intravenous treatment). Inclusion criteria were age 3 months to 16 years and first acute pyelonephritis episode, defined by fever of &amp;gt;38.5\u00b0C, C-reactive protein level of &amp;gt;20 mg\/L, and bacteriuria at &amp;gt;105\/mL. All patients underwent 99m technetium-dimercaptosuccinic acid scintigraphy 6 to 9 months after inclusion. A total of 548 children were included, 48 of whom were secondarily excluded and 117 of whom were lost to follow-up or had incomplete data; therefore, 383 children were eligible, 205 of them in the short intravenous treatment group and 178 in the long intravenous treatment group.<\/jats:p>\n                  <jats:p>RESULTS. At inclusion, median age was 15 months, median duration of fever was 43 hours, and median C-reactive protein level was 122 mg\/L. A total of 37% (143 of 383) of patients had a vesicoureteral reflux grades 1 to 3. Patient characteristics at inclusion were similar in both groups, except for a significantly higher proportion of girls in the short intravenous treatment group. The frequency of renal scars at scintigraphy was similar in both groups. Multivariate analysis demonstrated that renal scars were significantly associated with increased renal height at initial ultrasound and with the presence of grade 3 vesicoureteric reflux.<\/jats:p>\n                  <jats:p>CONCLUSIONS. The incidence of renal scars was similar in patients who received 3 days compared 8 days of intravenous ceftriaxone. Increased renal height at initial ultrasound examination and grade 3 vesicoureteric reflux were significant risk factors for renal scars.<\/jats:p>","DOI":"10.1542\/peds.2006-3632","type":"journal-article","created":{"date-parts":[[2008,2,11]],"date-time":"2008-02-11T20:44:29Z","timestamp":1202762669000},"page":"e553-e560","source":"Crossref","is-referenced-by-count":49,"title":["Prospective, Randomized Trial Comparing Short and Long Intravenous Antibiotic Treatment of Acute Pyelonephritis in Children: Dimercaptosuccinic Acid Scintigraphic Evaluation at 9 Months"],"prefix":"10.1542","volume":"121","author":[{"given":"Franc\u0327ois","family":"Bouissou","sequence":"first","affiliation":[{"name":"Ne\u0301phrologie Pe\u0301diatrique, Ho\u0302pital des Enfants, Universite\u0301 Paul Sabathier, Centre Hospitalier Universitaire Purpan, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"Munzer","sequence":"additional","affiliation":[{"name":"Ne\u0301phrologie Pe\u0301diatrique, Ho\u0302pital des Enfants, Universite\u0301 Paul Sabathier, Centre Hospitalier Universitaire Purpan, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ste\u0301phane","family":"Decramer","sequence":"additional","affiliation":[{"name":"Ne\u0301phrologie Pe\u0301diatrique, Ho\u0302pital des Enfants, Universite\u0301 Paul Sabathier, Centre Hospitalier Universitaire Purpan, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Roussel","sequence":"additional","affiliation":[{"name":"Ne\u0301phrologie Pe\u0301diatrique, American Memorial Hospital, Centre Hospitalier Universitaire Reims, Beims, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Novo","sequence":"additional","affiliation":[{"name":"Ne\u0301phrologie Pe\u0301diatrique, Ho\u0302pital Jeanne de Flandre, Universite\u0301 Lille 2, Centre Hospitalier Re\u0301gional Universitaire Lille, Lille, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denis","family":"Morin","sequence":"additional","affiliation":[{"name":"Ne\u0301phrologie Pe\u0301diatrique, Ho\u0302pital Arnaud de Villeneuve, Universite\u0301 Montpellier I, Centre Hospitalier Universitaire Montpellier, Montpellier, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Pierre","family":"Lavocat","sequence":"additional","affiliation":[{"name":"Ne\u0301phrologie Pe\u0301diatrique, Centre Hospitalier Universitaire Saint Etienne, Saint Etienne, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claude","family":"Guyot","sequence":"additional","affiliation":[{"name":"Ne\u0301phrologie Pe\u0301diatrique, Ho\u0302pital Me\u0300re Enfant, Universite\u0301 de Nantes, Centre Hospitalier Universitaire de Nantes, Nantes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie","family":"Taque","sequence":"additional","affiliation":[{"name":"Ne\u0301phrologie Pe\u0301diatrique, Centre Hospitalier Universitaire Rennes, Rennes, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Fischbach","sequence":"additional","affiliation":[{"name":"Ne\u0301phrologie Pe\u0301diatrique, Ho\u0302pital Hautepierre, Universite\u0301 Louis Pasteur, Centre Hospitalier Universitaire Strasbourg, Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Ouhayoun","sequence":"additional","affiliation":[{"name":"Me\u0301decine Nucle\u0301aire, Universite\u0301 Paul Sabathier, Centre Hospitalier Universitaire Purpan Toulouse, Toulouse, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the French Society of Nuclear Medicine and Molecular Imaging","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantal","family":"Loirat","sequence":"additional","affiliation":[{"name":"Service de Ne\u0301phrologie, Faculte\u0301 de Me\u0301decine Denis Diderot, Universite\u0301 Paris VII, Ho\u0302pital Robert Debre\u0301, Assistance Publique-Ho\u0302pitaux de Paris, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the French Society of Pediatric Nephrology","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2008,3,1]]},"reference":[{"key":"2021120905494269600_R1","doi-asserted-by":"crossref","unstructured":"Hellstro\u0308m A, Hanson E, Hansson S, Hja\u0308lma\u030as K, Jodal U. Association between urinary symptoms at 7 years old and previous urinary tract infections. Arch Dis Child.1991;66(2):232\u2013234","DOI":"10.1136\/adc.66.2.232"},{"key":"2021120905494269600_R2","unstructured":"Messi G, Peratoner L, Paduano L, et al. Epidemiology of urinary tract infection and vesicoureteral reflux in children. Helv Paediatr Acta.1989;43(5\u20136):389\u2013396"},{"key":"2021120905494269600_R3","doi-asserted-by":"crossref","unstructured":"Hoberman A, Chao HP, Keller D, Hickey R, Davis HW, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr.1993;123(1):17\u201323","DOI":"10.1016\/S0022-3476(05)81531-8"},{"key":"2021120905494269600_R4","doi-asserted-by":"crossref","unstructured":"Jacobson S, Eklo\u0308f O, Lins LE, Wikstad I, Winberg J. Long-term prognosis of post-infectious renal scarring in relation to radiological findings in childhood: a 27-year follow-up. Pediatr Nephrol.1992;6(1):19\u201324","DOI":"10.1007\/BF00856822"},{"key":"2021120905494269600_R5","unstructured":"Pistor K, Scha\u0308rer K, Olbing H, Tamminen-Mo\u0308bius T. Children with chronic renal failure in the Federal Republic of Germany: II\u2014primary renal diseases, age and intervals from early renal failure to renal death. Clin Nephrol.1985;23(6):278\u2013284"},{"key":"2021120905494269600_R6","doi-asserted-by":"crossref","unstructured":"Esbjo\u0308rner E, Aronson S, Berg U, Jodal U, Linne T. Children with chronic renal failure in Sweden 1978\u20131985. Pediatr Nephrol.1990;4(3):249\u2013252","DOI":"10.1007\/BF00857667"},{"key":"2021120905494269600_R7","doi-asserted-by":"crossref","unstructured":"Lahdes-Vasama T, Niskanen K, Ronnholm K. Outcome of kidneys in patients treated for vesicoureteral reflux (VUR) during childhood. Nephrol Dial Transplant.2006;21(9):2491\u20132497","DOI":"10.1093\/ndt\/gfl216"},{"key":"2021120905494269600_R8","doi-asserted-by":"crossref","unstructured":"Rushton HG, Majd M. Dimercaptosuccinic acid renal scintigraphy for the evaluation of pyelonephritis and scarring: a review of experimental and clinical studies. J Urol.1992;148(5 pt 2):1726\u20131732","DOI":"10.1016\/S0022-5347(17)37014-3"},{"key":"2021120905494269600_R9","doi-asserted-by":"crossref","unstructured":"Verboven M, Ingels M, Delree M, Piepsz A. 99m Tc-DMSA scintigraphy in acute urinary tract infection in children. Pediatr Radiol.1990;20(7):540\u2013542","DOI":"10.1007\/BF02011385"},{"key":"2021120905494269600_R10","doi-asserted-by":"crossref","unstructured":"Kass E, Fink-Bennett D, Cacciarelli A, Balon H, Pavlock S. The sensitivity of renal scintigraphy and sonography in detecting nonobstructive acute pyelonephritis. J Urol.1992;148(2 pt 2):606\u2013608","DOI":"10.1016\/S0022-5347(17)36667-3"},{"key":"2021120905494269600_R11","doi-asserted-by":"crossref","unstructured":"Mackenzie JR. A review of renal scarring in children. Nucl Med Commun.1996;17(3):176\u2013190","DOI":"10.1097\/00006231-199603000-00002"},{"key":"2021120905494269600_R12","doi-asserted-by":"crossref","unstructured":"Majd M, Rushtion HG. Renal cortical scintigraphy in the diagnosis of acute pyelonephritis. Semin Nucl Med.1992;22(2):98\u2013111","DOI":"10.1016\/S0001-2998(05)80085-6"},{"key":"2021120905494269600_R13","doi-asserted-by":"crossref","unstructured":"Erb A, Sturmer T, Marre R, Bremmer M. Prevalence of antibiotic resistance in Escherichia coli: overview of geographical, temporal, and methodological variations. Eur J Clin Microbiol Infect Dis.2007;26(2):83\u201390","DOI":"10.1007\/s10096-006-0248-2"},{"key":"2021120905494269600_R14","doi-asserted-by":"crossref","unstructured":"Bloomfield P, Hodson EM, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev.2005;(1):CD003772","DOI":"10.1002\/14651858.CD003772.pub2"},{"key":"2021120905494269600_R15","unstructured":"Ramage IJ, Bridges HG, Beattie TJ. An audit of the clinical management of urinary tact infection in childhood. Health Bull (Edinb).1995;53(5):260\u2013268"},{"key":"2021120905494269600_R16","unstructured":"Bensman E, Leroy B. Treatment of urinary infection in children [in French]. Presse Med.1993;22(38):1916\u20131920"},{"key":"2021120905494269600_R17","doi-asserted-by":"crossref","unstructured":"Cornu C, Cochat P, Collet JP, Delair S, Haugh MC, Rolland C. Survey of the attitudes to management of acute pyelonephritis in children. Pediatr Nephrol.1994;8(3):275\u2013277","DOI":"10.1007\/BF00866331"},{"key":"2021120905494269600_R18","doi-asserted-by":"crossref","unstructured":"Levtchenko EN, Ham HR, Levy J, Piepsz A. Attitude of Belgian pediatricians toward strategy in acute pyelonephritis. Pediatr Nephrol.2001;16(2):113\u2013115","DOI":"10.1007\/s004670000531"},{"key":"2021120905494269600_R19","doi-asserted-by":"crossref","unstructured":"Michael M, Hodson EM, Craig JC, Martin S, Moyer VA. Short compared with standard duration of antibiotic treatment for urinary tract infection: a systematic review of randomised controlled trials. Arch Dis Child.2002;87(2):118\u2013123","DOI":"10.1136\/adc.87.2.118"},{"key":"2021120905494269600_R20","doi-asserted-by":"crossref","unstructured":"Hoberman A, Wald ER, Hickey RW, et al. Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics.1999;104(1 pt 1):127\u2013129","DOI":"10.1542\/peds.104.1.79"},{"key":"2021120905494269600_R21","doi-asserted-by":"crossref","unstructured":"Benador D, Neuhaus TJ, Papazyan J-P, et al. Randomised controlled trial of three day versus 10 day intravenous antibiotics in acute pyelonephritis: effect on renal scarring. Arch Dis Child.2001;84(3):241\u2013246","DOI":"10.1136\/adc.84.3.241"},{"key":"2021120905494269600_R22","unstructured":"Vilaichone A, Watana D, Chaiwatanarat T. Oral ceftibuten switch therapy for acute pyelonephritis in children. J Med Assoc Thai.2001;84(suppl 1):61\u201367"},{"key":"2021120905494269600_R23","doi-asserted-by":"crossref","unstructured":"Levtchenko E, Lahy C, Levy J, Ham H, Piepsz A. Treatment of children with acute pyelonephritis: a prospective randomized study. Pediatr Nephrol.2001;16(11):878\u2013884","DOI":"10.1007\/s004670100690"},{"key":"2021120905494269600_R24","doi-asserted-by":"crossref","unstructured":"Mackenzie JR. DMSA: the new \u201cgold standard. \u201d Nucl Med Commun.1990;11:725\u2013726","DOI":"10.1097\/00006231-199011000-00001"},{"key":"2021120905494269600_R25","doi-asserted-by":"crossref","unstructured":"Piepsz A, Hahn K, Roca I, et al. A radiopharmaceuticals schedule for imaging in paediatrics. Pediatric Task Group of the European Association in Nuclear Medicine. Eur J Nucl Med.1990;17(3\u20134):127\u2013129","DOI":"10.1007\/BF00811439"},{"key":"2021120905494269600_R26","doi-asserted-by":"crossref","unstructured":"Patel K, Charron M, Hoberman A, Brown ML, Rogers KD. Intra- and interobserver variability interpretation of DMSA scans using a set of standardized criteria. Pediatr Radiol.1993;23(7):506\u2013509","DOI":"10.1007\/BF02012131"},{"key":"2021120905494269600_R27","unstructured":"Fleiss JL. Statistical Methods for Rates and Proportions. 2nd ed. New York, NY: Wiley;1981:38\u201345"},{"key":"2021120905494269600_R28","doi-asserted-by":"crossref","unstructured":"Wellek S, Michaelis J. Element of significance testing with equivalents problems. Methods Inf Med.1991;30(3):194\u2013198","DOI":"10.1055\/s-0038-1634835"},{"key":"2021120905494269600_R29","unstructured":"Bouyer J. Logistic regression and epidemiology: I [in French]. Rev Epidemiol Sante Publique.1991;39(1):79\u201387"},{"key":"2021120905494269600_R30","unstructured":"Bouyer J. Logistic regression and epidemiology: II [in French]. Rev Epidemiol Sante Publique.1991;39(2):183\u2013196"},{"key":"2021120905494269600_R31","doi-asserted-by":"crossref","unstructured":"Jakobsson B, Svensson L. Transient pyelonephritic changes on 99mTechnetium-dimercaptosuccinic acid scan for at least five months after infection. Acta Paediatr.1997;86(8):803\u2013807","DOI":"10.1111\/j.1651-2227.1997.tb08601.x"},{"key":"2021120905494269600_R32","doi-asserted-by":"crossref","unstructured":"Benador D, Benador N, Slosman D, Nussle\u0301 D, Mermillod B, Girardin E. Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis. J Pediatr.1994;124(1):17\u201320","DOI":"10.1016\/S0022-3476(94)70248-9"},{"key":"2021120905494269600_R33","doi-asserted-by":"crossref","unstructured":"Craig WA. Pharmacokinetic\/pharmacodynamic parameters: rationale for antibacterial dosing of mice and men. Clin Infect Dis.1998;26(1):1\u201310","DOI":"10.1086\/516284"},{"key":"2021120905494269600_R34","doi-asserted-by":"crossref","unstructured":"Frimodt-M\u00f8ller N. Correlation between pharmacokinetic\/pharmacodynamic parameters and efficacy for antibiotics in the treatment of urinary tract infection. Int J Antimicrob Agents.2002;19(6):546\u2013553","DOI":"10.1016\/S0924-8579(02)00105-X"},{"key":"2021120905494269600_R35","unstructured":"Risdon RA, Yeung CK, Ransley PG. Reflux nephropathy in children submitted to unilateral nephrectomy: a clinicopathological study. Clin Nephrol.1993;40(6):308\u2013314"},{"key":"2021120905494269600_R36","doi-asserted-by":"crossref","unstructured":"Gordon I, Barkovics M, Pindoria S, Cole TJ, Woolf AS. Primary vesicoureteric reflux as a predictor of renal damage in children hospitalized with urinary tract infection: a systematic review and meta-analysis. J Am Soc Nephrol.2003;14(3):739\u2013744","DOI":"10.1097\/01.ASN.0000053416.93518.63"},{"key":"2021120905494269600_R37","doi-asserted-by":"crossref","unstructured":"Garin EH, Olavarria F, Nieto VG, Valenciano B, Campos A, Young L. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics.2006;117(3):626\u2013632","DOI":"10.1542\/peds.2005-1362"},{"key":"2021120905494269600_R38","doi-asserted-by":"crossref","unstructured":"Polito C, Rambaldi PF, Signoriello G, Mansi L, La Manna A. Permanent renal parenchymal defects after febrile UTI are closely associated with vesicoureteric reflux. Pediatr Nephrol.2006;21(4):521\u2013526","DOI":"10.1007\/s00467-006-0036-3"},{"key":"2021120905494269600_R39","unstructured":"Chroustova\u0301 D, Palyzova D, Urbanova I, Kolska M. Results of a five-year study of (99m)Tc DMSA renal scintigraphy in children and adolescents following acute pyelonephritis. Nucl Med Rev Cent East Eur.2006;9(1):46\u201350"},{"key":"2021120905494269600_R40","doi-asserted-by":"crossref","unstructured":"Sweeney B, Cascio S, Velayudham M, Puri P. Reflux nephropathy in infancy: a comparison of infants presenting with and without urinary tract infection. J Urol.2001;166(2):648\u2013650","DOI":"10.1016\/S0022-5347(05)66036-3"},{"key":"2021120905494269600_R41","doi-asserted-by":"crossref","unstructured":"Connolly LP, Treves ST, Connolly SA, et al. Vesicoureteral reflux in children: incidence and severity in siblings. J Urol.1997;157(6):2287\u20132290","DOI":"10.1016\/S0022-5347(01)64764-5"},{"key":"2021120905494269600_R42","doi-asserted-by":"crossref","unstructured":"Ataei N, Madani A, Esfahani ST, et al. Screening for vesicoureteral reflux and renal scars in siblings of children with known reflux. Pediatr Nephrol.2004;19(10):1127\u20131131","DOI":"10.1007\/s00467-004-1539-4"},{"key":"2021120905494269600_R43","doi-asserted-by":"crossref","unstructured":"Bonnin F, Lottmann H, Sauty L, et al. Scintigraphic screening for renal damage in siblings of children with symptomatic primary vesico-ureteric reflux. BJU Int.2001;87(6):463\u2013466","DOI":"10.1046\/j.1464-410X.2001.00097.x"},{"key":"2021120905494269600_R44","doi-asserted-by":"crossref","unstructured":"Taskinen S, Ronnholm K. Post-pyelonephritic renal scars are not associated with vesicoureteral reflux in children. J Urol.2005;173(4):1345\u20131348","DOI":"10.1097\/01.ju.0000152321.16833.f5"},{"key":"2021120905494269600_R45","doi-asserted-by":"crossref","unstructured":"Glauser MP, Meylan P, Bille J. The inflammatory response and tissue damage. Pediatr Nephrol.1987;1(4):615\u2013622","DOI":"10.1007\/BF00853599"},{"key":"2021120905494269600_R46","doi-asserted-by":"crossref","unstructured":"O'Riordan E, Gross SS, Goligorsky MS. Technology Insight: renal proteomics\u2014at the crossroads between promise and problems. Nat Clin Pract Nephrol.2006;2(8):445\u2013458","DOI":"10.1038\/ncpneph0241"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/121\/3\/e553\/1122164\/zpe0030800e553.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/121\/3\/e553\/1122164\/zpe0030800e553.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T18:41:26Z","timestamp":1639075286000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/121\/3\/e553\/72844\/Prospective-Randomized-Trial-Comparing-Short-and"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,3,1]]},"references-count":46,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2008,3,1]]},"published-print":{"date-parts":[[2008,3,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2006-3632","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.1104520.560563","asserted-by":"object"}]},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,3,1]]}}}