Randomised controlled trials (RCTs) of patients of any age hospitalised due to acute pyelonephritis were eligible for inclusion in the review. Trials needed to compare intravenous antibiotic regimens (either not switched to oral antibiotic treatment until the end of the study period or switched to oral antibiotic treatment later than the comparator arm) with treatment regimens initially administered or followed by an early switch to oral treatment. Time of switching could be according to an individual study protocol or from patients' clinical response. Early switch was defined as administration of oral antibiotics after at least one day of initial treatment with intravenous antibiotics. Definitions were provided by the authors for acute pyelonephritis, concomitant treatment and the outcomes of interest.
Conference abstracts, letters and commentaries were excluded from the review. Studies published in languages other than English, Spanish, French, German, Italian and Greek were excluded.
The review included six trials of paediatric populations and two of adult populations. A range of intravenous and oral antibiotic treatment regimens and concomitant treatments was used. Timing of switch from intravenous to oral antibiotics varied (full details in the paper). Duration of treatment varied across the trials from five to 21 days. Total duration of treatment was the same in both treatment arms in all except one trial. Follow-up varied between three days and nine months post-treatment. Outcomes assessed were renal scarring, microbiological eradication, clinical success, reinfection and persistence and adverse events.
The authors did not state how many reviewers performed the study selection.