Rise of the beta-lactams: a retrospective, comparative cohort of oral beta-lactam antibiotics as step-down therapy for hospitalized adults with acute pyelonephritis
Abstract
Objective: The aim of this study was to determine if oral beta-lactam therapy is non-inferior to alternative therapy at discharge following inpatient treatment with an IV cephalosporin for acute pyelonephritis.
Design: Institutional Review Board (IRB)-approved, multicenter, retrospective, non-inferiority cohort (15% non-inferiority margin).
Setting: Six hospitals within two healthcare systems.
Patients: Hospitalized patients admitted to the medical floor with acute pyelonephritis without urologic abnormalities who received cefazolin or ceftriaxone followed by step-down therapy.
Methods: Patients were discharged with either an oral beta-lactam or an oral alternative agent (ie, fluoroquinolone or trimethoprim-sulfamethoxazole) to complete therapy. The primary objective was treatment failure defined as a composite of hospital readmission or an ED visit for a urinary cause within 30 days of discharge of the index hospitalization. Data were extracted manually from the electronic medical record.
Results: A total of 211 patients were included; 122 received an oral beta-lactam and 89 received an oral alternative agent at discharge. There was no difference in 30-day treatment failure between the two groups (4.9% vs 5.6% for oral beta-lactams vs oral alternatives, respectively. Absolute difference = 0.7%; 95% CI -5.4% to 6.8%; P = .82). The median length of hospital stay, number of patients treated with intravenous ceftriaxone, duration of IV therapy, and median duration of oral…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 211 participants or records.
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