Antibiotic therapies currently recommended for the treatment of acute pyelonephritis (AP) in children, whether fully by the oral route or initially intravenous (IV, 3 days) followed by the oral route, have a duration of 7 to 14 days (10 days in France).
In children with no prior urological malformation, the global clinical and microbiological cure rate after antibiotic treatment completion is around 95%. Recurrence occurs in less than 5% of cases in the 3 months following AP. Renal scarring, when documented, concerns 15% of children 6 months after treatment. Renal scarring can be associated with chronic renal disease.
The investigators hypothesize that 3 days of IV treatment is equivalent to extending to 10 days with an oral to treat AP in children.
The investigators also hypothesize that while achieving equivalent clinical and prevention of re-infections in the following 3 months, 3 days of IV treatment reduces the risk of acquisition of resistant strains of Enterobacteriaceae and increases the gut microbotia diversity compared to extending to 10 days with an oral therapy.
Age ≥ 1 month and < 3 years
For children younger than 3 months, gestational age > 34 WA
First episode of urinary tract infection
AP defined by temperature ≥ 38°C on day of diagnosis AND positive urinalysis (white cell counts ≥ 10^4/mL) with a positive urine culture with one Gram- negative bacillus ≥ 104 UFC/mL. The child temperature will have to be measured with a thermometer according to the French national recommendations [Health Insurance website (AMELI ;see: - https://www.ameli. fr/assure/sante/bons-gestes/soins/prendre-temperature); HAS (see: https://www.has-sante. fr/jcms/c_2674284/fr/prise-en-charge-de-la-fievre-chez-l-enfant)].
None
Parallel
IV Antibacterial Agents
DrugCeftriaxone (50 mg/kg once a day by intravenous/intramuscular route) AND/OR Amikacin (20 mg/kg once a day by intravenous/intramuscular route) during 3 days. .
Orally antibacterial agents
DrugCotrimoxazole (sulfamethoxazole/trimethoprime) 30mg/kg/day (2 divided doses) OR Cefixime 8mg/kg/day (2 divided doses) during 7 days
Fecal/Rectal Swab
Procedure/SurgeryCollected by the nurse or the physician (D0,D3,D10 or 17 and D31 or D38), either by a rectal swab, either by fecal swab (dip of the swab in fresh stools \< 4 hours, which will occur frequently in our population of children aged 1 month to 3 years, and will in particular be possible for hospitalized children) using a FecalSwabTM, that contains a transport medium.
PCT assay
Procedure/SurgeryDosage of procalcitonin (if not performed in standard care) at D0
Recurrence of febrile urinary tract infection
Demonstrate the non-inferiority of a 3-day intravenous (IV) antibiotic therapy versus a 3-day IV therapy followed by a 7-day oral antibiotic therapy for the treatment of AP in children in term of the is recurrence of febrile urinary tract infection within a 28 -days period after the completion of antibiotic treatment respectively at D31 (+/- 3 days) for the experimental group and D38 (+/- 3 days) for the control group.. The recurrence will be defined as: fever ≥ 38°C associated with a positive urinalysis (white cell counts ≥ 10\^4/mL) with a positive urine culture with one Gram-negative bacillus ≥ 10\^4 UFC/mL
Clinical cure
Demonstrate the non-inferiority of a 3-day IV antibiotic treatment versus a 3-day IV followed by 7-day oral antibiotic treatment for AP in children 1 month to 3 years old in terms of clinical cure, defined by apyrexia AND absence of signs suggestive or urinary infection (abdominal pain, urinary function signs) AND no feeding problem collecting during a medical visit. .
Recurrence of AP
Demonstrate the non-inferiority of a 3-day IV antibiotic treatment versus a 3-day IV/IM followed by 7-day oral antibiotic treatment for AP in children 1 month to 3 years old in terms of recurrence of AP collecting during a phone call.
Colonization with antimicriobial-resistant Enterobacteriaceae
Compare between the two treament arms the rate of colonization with antimicrobial-resistant Enterobacteriaceae in the gastrointestinal tract
Bacterial diversity of the intestinal microbiota
Compare between the two treament arms the bacterial diversity of the intestinal microbiota : alpha-diversity measured by Shannon's index.
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