Short-Course Treatment for Acute Pyelonephritis?

Mary E. Wilson, MD


Journal Watch 

In This Article

Abstract and Introduction


In women with acute pyelonephritis, a 7-day course of ciprofloxacin was not inferior to a 14-day course.


Although acute pyelonephritis is common in women, few controlled trials have been done to assess the optimum duration of therapy for this infection. To provide more data, researchers in Sweden conducted a prospective, multicenter, noninferiority trial of ciprofloxacin for 7 days and 14 days.

A total of 248 nonpregnant women aged ≥18 with community-acquired acute pyelonephritis (fever≥38°C and ≥1 sign or symptom related to the urinary tract) were randomized to short- or longer-course therapy. During the first week, all participants received oral ciprofloxacin (500 mg twice daily); during the second week, women in the short-course group received placebo, and those in the longer-course group continued on ciprofloxacin. Participants were hospitalized or managed as outpatients at the attending physician's discretion. Patients whose initial cultures yielded Escherichia coli with resistance — or reduced susceptibility — to ciprofloxacin were excluded.

Of 156 participants (median age, 46) included in the per-protocol population, 97% in the 7-day group and 96% in the 14-day group showed clinical cure at follow-up 10 to 14 days after treatment with the active drug. At long-term follow-up (days 42–63), the cumulative cure rate was 93% in both groups. Blood cultures were obtained in 155 patients before antibiotic initiation; 27% grew E. coli. Cure rates were similar, regardless of blood-culture results, and — in patients with positive blood cultures — between 7- and 14-day courses. Treatment was well tolerated. Potentially drug-related adverse events were reported by 5% in the 7-day group and 6% in the 14-day group; two women discontinued therapy because of such events. Mucosal candidiasis developed in five patients receiving the longer course and in none receiving the short course.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.