Randomized Clinical Trial of Antibiotic Therapy for Antenatal Pyelonephritis

[摘要] Objective:The aim of this study was to prospectively evaluate the efficacy of a therapeutic courseof intravenous antibiotics followed by oral antibiotics vs. intravenous antibiotics alone to preventrecurrent urinary tract infection.Methods:Pyelonephritis was documented by strict criteria in 67 pregnant women who were thentreated with appropriate intravenous antibiotics until afebrile and asymptomatic for 48 h. Womenwere then randomized to completion of a 10-day course of oral nitrofurantoin 100 mg qid or nofurther antibiotic therapy. Urine cultures (UC) were obtained 2 and 6 weeks after discharge, andat delivery. A positive UC or readmission for pyelonephritis was considered endpoints for participationin the study. Antibiotic suppression was not used.Results:Readmission for pyelonephritis prior to the 2-week follow-up visit occurred in 2/36(5.6%) women randomized to the oral therapy group compared to 4/31 (12.9%) in the no oraltreatment group (P= 0.29). At the 2-week follow-up visit, 6/31 (19.4%) women had a positive UCin the oral therapy compared to 8/26 (30.1%) in the no oral treatment group but this difference wasnot statistically significant (P= 0.31).Conclusions:Completion of 10 days of antibiotic therapy with oral medication does not significantlyreduce the risk of recurrent pyelonephritis immediately post-parenteral treatment. Women inthe no oral treatment group had a non-significant increase in positive UC at the 2-week follow-upvisit. The high rates of recurrent urinary tract infection during pregnancy in both groups underscorethe need for regular UC and for the possible role of oral antibiotic suppression.

[学科分类] 妇产科学