Short vs long-course antibiotic therapy in pyelonephritis: a comparison of systematic reviews and guidelines for the SIMI choosing wisely campaign

Luca Erba, Ludovico Furlan, Alice Monti, Elisa Marsala, Giulia Cernuschi, Monica Solbiati, Christian Bracco, Giulia Bandini, Monica Pecorino Meli, Giovanni Casazza, Nicola Montano, Rodolfo Sbrojavacca, Giorgio Costantino

Research output: Contribution to journalArticlepeer-review


Background: The Italian Society of Internal Medicine (SIMI) Choosing Wisely Campaign has recently proposed, among its five items, to reduce the prescription of long-term intravenous antibiotics if not indicated. The aim of our study was to assess the available evidences on optimal duration of antibiotic treatment in pyelonephritis through a systematic review of secondary studies. Materials and methods: We searched for all guidelines on pyelonephritis and systematic reviews assessing the optimal duration of antibiotic therapy in this type of infection. We compared the recommendations of the three most cited and recent guidelines on the topic of interest. We extracted data of non-duplicated RCT from the selected systematic reviews and performed meta-analyses for clinical and microbiological failure. A trial sequential analysis (TSA) was also achieved to identify the need for further evidence. Results: We identified 4 systematic reviews, including data from 10 non-duplicated RCTs (1536 patients). The meta-analysis showed a higher rate of clinical cure for short-course antibiotic treatment (RR for clinical failure 0.70, 95% CI [0.53–0.94]). No significant difference in the rate of microbiological failure (RR 1.06, 95% CI [0.75–1.49]) was observed. In terms of clinical cure, the TSA suggests that current evidence is sufficient to consider short course at least as effective as long-course treatment. Selected guidelines recommend considering shorter courses, but do not cite most of the published RCTs. Conclusions: Short-course antibiotic treatment is at least as effective as longer courses for both microbiological and clinical success in the treatment of acute uncomplicated pyelonephritis.

Original languageEnglish
Pages (from-to)313-323
JournalInternal and Emergency Medicine
Issue number2
Publication statusPublished - 2021


  • Antibiotic treatment
  • Choosing wisely
  • Guidelines
  • Pyelonephritis
  • Systematic review
  • Urinary tract infection

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine


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