Randomised controlled trials (RCTs) which compared short-course (seven to 14 days) with long-course (14 to 42 days) antibiotic treatment with the same agent and dose in the treatment of acute pyelonephritis in adults or adolescents (aged at least 15 years) were eligible for inclusion. Primary outcomes were clinical success, bacteriologic efficacy, relapses, recurrences, adverse events and patient withdrawals due to adverse events. Studies in which results for a subgroup of patients with acute pyelonephritis were reported separately were eligible for inclusion.
Included trials used the following antibiotic regimes: intravenous fleroxacin followed by oral fleroxacin; oral ampicillin or oral trimethoprim plus sulfamethoxazole; oral pivampicillin plus pivmecillinam; or intravenous gentamicin or tobramycin followed by one of three antibiotics orally. Doses and regimens varied between the studies. Duration of short courses was seven, 10 or 14 days; duration of long courses was 14, 21 or 42 days. The majority of patients in all studies were women.
Two reviewers independently assessed the studies for inclusion in the review.