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Objectif Confirmer qu’une antibiotherapie orale d’emblee est aussi efficace qu’une antibiotherapie sequentielle intraveineuse puis orale pour prevenir les cicatrices renales chez des enfants de 1 a 36 mois ayant un premier episode de pyelonephrite aigue (PNA).

Objective To evauluate the relationship between propionic acidemia (PA) and cardiomyopathy. Study design We retrospectively compared clinical and metabolic results of patients with PA with and without cardiomyopathy. Results Of 26 patients with PA who survived the first year of age, a dilated cardiomyopathy developed in 6 (group 1) at a median age of 7 years (range, 5-11 years). They were compared with 14 patients without cardiomyopathy for whom data were available (group 2). Their median age at the time of the study was 11 years (range, 3-21 years). PA was diagnosed in the neonatal period in 5 of 6 patients in group 1 and 11 of 14 patients in group 2. All patients received similar medical treatment. Two patients in group 1 died of cardiac arrest. In 2 patients, the cardiomyopathy was reversed during the year after orthotopic liver transplantation (OLT). In 2 other patients, OLT was contraindicated because of severe heart disease. The number of metabolic distress episodes was similar in both groups. Excretion of propionate metabolites in urine did not correlate with the occurrence of cardiomyopathy. Conclusion Dilated cardiomyopathy, a frequent complication of PA, develops independent of any specific metabolic profile and is reversible after OLT.

OBJECTIVE: To confirm whether oral antibiotic treatment is as efficacious as sequential intravenous/oral antibiotic treatment in the prevention of renal scarring in children with acute pyelonephritis and scintigraphy-documented acute lesions. METHODS: In a prospective multicenter trial, children aged 1 to 36 months with their first case of acute pyelonephritis, a serum procalcitonin concentration ≥0.5 ng/mL, no known uropathy, and a normal ultrasound exam were randomized into 2 treatment groups. They received either oral cefixime for 10 days or intravenous ceftriaxone for 4 days followed by oral cefixime for 6 days. Patients with acute renal lesions detected on early dimercaptosuccinic acid scintigraphy underwent a follow-up scintigraphy 6 to 8 months later. RESULTS: The study included 171 infants and children. There were no significant differences between the 2 groups in any clinical characteristic. Initial scintigraphy results were abnormal for 119 children. Ninety-six children were measured for renal scarring at the follow-up scintigraphy (per protocol analysis population). The incidence of renal scarring was 30.8% in the oral treatment group and 27.3% for children who received the sequential treatment. CONCLUSIONS: Although this trial does not statistically demonstrate the noninferiority of oral treatment compared with the sequential treatment, our study confirmed the results of previously published reports and therefore supports the use of an oral antibiotic treatment of primary episodes of acute pyelonephritis in infants and young children.

Nous avons compare l’efficacite lors d’une premiere pyelonephrite chez l’enfant d’un traitement oral (PO) (cefixime) et d’un traitement sequentiel intraveineux (ceftriaxone) puis oral (cefixime) (IV/PO) sur le risque de cicatrice renale. Cent soixante et onze enfants de 1 mois a 3 ans ont ete inclus. Apres une scintigraphie au DMSA pathologique a la phase aigue, l’efficacite du traitement etait evaluee sur la presence d’une cicatrice renale sur une scintigraphie a 6 mois. Resultats : En intention de traiter, le risque de cicatrice renale n’etait pas significativement different entre les 2 groupes : 25/61(41 %) enfants traites PO versus 26/58 (44,8 %) enfants traites IV/PO. Dans l’analyse per protocole, le risque de cicatrice n’etait pas non plus significativement different: 16/52 (30,8 %) enfants traites PO et 12/44 enfants (27,3 %) traites IV/PO. Le delai d’apyrexie, l’incidence de reflux ne differaient pas dans les 2 groupes. Conclusion : Un traitement oral donne des resultats comparables a un traitement sequentiel sur le risque de cicatrice renale a distance apres une premiere pyelonephrite chez l’enfant de 1 mois a 3 ans. Ces resultats sont similaires a ceux rapportes precedemment [1-3] .