SynthesisEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology2026
Management of acute pyelonephritis: a systematic review of oral versus single-dose intravenous followed by oral antibiotic treatment.
Synthesis in European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Corrections and comments
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Authors and funding
6 authors.
Funding
Abstract
purposeAcute pyelonephritis is a common diagnosis in ambulatory settings. The objective of this systematic review was to assess whether oral antibiotic treatment is non-inferior to a single dose of IV antibiotics followed by oral relay in terms of efficacy and complications in adult patients presenting to the emergency department (ED) with acute pyelonephritis.
methodsThe protocol was registered to PROSPERO (CRD42024503968). Five databases (MEDLINE, Embase, CINAHL, CENTRAL, and Web of Science) and grey literature were searched for randomized controlled trials (RCT) and observational studies comparing both treatment strategies. Two reviewers independently performed study selection, data extraction, and quality assessment (RoB 2 and ROBINS-I). The primary outcomes were clinical and microbiological cure. A structured reporting of the effects for each study was conducted since meta-analysis was not appropriate.
resultsThe search yielded 2,956 records, with 909 duplicates. After screening, 40 full texts were reviewed, and 3 studies were included. Two studies (1 RCT, 1 non-randomized) reported on the primary outcomes, without assessing non-inferiority. These did not report a difference in clinical and microbiological cure between treatment strategies at end of follow-up. The risk of bias was moderate to serious/high.
conclusionThis review identified few studies comparing oral-only to single-dose IV followed by oral antibiotics for acute pyelonephritis in adults. Non-inferiority of oral-only treatment could not be established, as none of the included studies were designed for this purpose. Clarifying the comparative effectiveness of these two approaches is essential to further optimize the management of acute pyelonephritis.
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41222820What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.