***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Pregnant patients with symptomatic and asymptomatic urinary tract infections were treated with a long and a short antibiotic regimen . Two hundred two patients were r and omized prospect ively to a single oral dose of 3.5 g ampicillin plus 1 g probenecid ( 98 patients ) versus 500 mg ampicillin orally four times a day for 10 days ( 104 patients ) . The multiple-dose cure rate was statistically significantly better than that of the single-dose regimen ( 67.3 % versus 57.1 % , respectively ) . Interestingly , for resistant organisms , the cure rate for the long and short regimens was similar ( 48 % versus 43 % , respectively ) . In vitro susceptibility testing does not appear to be a good predictor of cure , at least for the single-dose group . Single-dose therapy with ampicillin and probenecid does not provide an optimal cure rate or prevent reinfection during pregnancy . Possible reasons for these findings are discussed OBJECTIVE To compare outpatient to inpatient management of acute pyelonephritis in pregnancy beyond 24 weeks ' gestation . METHODS Ninety-two gravidas past 24 weeks ' gestation , r and omized to outpatient or inpatient therapy  , received two 1-g doses of intramuscular ceftriaxone at 24-hour intervals while hospitalized , then were discharged and reevaluated within 48 - 72 hours or remained hospitalized until afebrile for 48 hours . Subjects received oral cephalexin after initial treatment . Urine cultures were done on admission and 5 - 14 days after therapy . Surveillance continued until delivery . We anticipated that 15 % of out patients and 0.01 % of in patients would require changes in antibiotic therapy . RESULTS Twenty-one percent of women evaluated were excluded . Thirteen of 46 ( 28 % ) out patients ' hospitalization exceeded 24 hours . Six out patients ( 13.0 % ) and one inpatient did not respond to initial therapy and were treatment failures ( relative risk [ RR ] 1.82 , 95 % confidence interval [ CI ] 1.00 , 3.31 ) . Within 2 weeks of initial therapy , seven of 81 ( 8.6 % ) subjects had positive urine cultures , four out patients versus three in patients ( P > .999 ) . Eleven of 84 ( 13.1 % ) deliveries for which birth data were available occurred preterm ( six of 41 out patients versus five of 43 in patients ) ( RR 1.14 , 95 % CI 0.61 , 2.11 ) . CONCLUSION There were no significant differences in clinical responses or birth outcomes of in patients or out patients treated for acute pyelonephritis after 24 weeks ' gestation if they completed their assigned protocol s. Thirty percent of out patients were unable to , and most women with acute pyelonephritis in the third trimester were not c and i date s for outpatient therapy In an open comparative study 400 patients with urinary tract infections were r and omly allocated to two treatment groups . In 202 patients an immune stimulation against uropathogenic bacteria was produced with a new preparation , SolcoUrovac , and only in exceptional cases with pronounced symptomatology was antibiotic therapy given , while in the control group ( n = 198 ) all patients were treated with nitrofurantoin or with another appropriate antibiotic , according to the antibiogram . In the subsequent 12-month observation period 28 infections occurred in 23 patients of the immune-stimulated group and 84 in 47 patients of the control group . This difference is statistically significant ( p less than or equal to 0.001 ) . The preventive effect of the SolcoUrovac therapy was particularly impressive in patients with recurrent urinary tract infections . Thirty-two patients from each group with similar case histories , as matched pairs , were evaluated separately . The relapse rate in the 12-month observation period amounted to 2 re-infections in the group treated with immunotherapy and to 29 in the control group . All side-effects were recorded . No adverse effects were observed in pregnant women or in their offspring Objective : The aim of this study was to prospect ively evaluate the efficacy of a therapeutic course of intravenous antibiotics followed by oral antibiotics vs. intravenous antibiotics alone to prevent recurrent urinary tract infection . Methods : Pyelonephritis was documented by strict criteria in 67 pregnant women who were then treated with appropriate intravenous antibiotics until afebrile and asymptomatic for 48 h. Women were then r and omized to completion of a 10-day course of oral nitrofurantoin 100 mg qid or no further antibiotic therapy .  Urine cultures ( UC ) were obtained 2 and 6 weeks after discharge , and at delivery . A positive UC or readmission for pyelonephritis was considered endpoints for participation in the study . Antibiotic suppression was not used . Results : Readmission for pyelonephritis prior to the 2-week follow-up visit occurred in 2/36 ( 5.6 % ) women r and omized to the oral therapy group compared to 4/31 ( 12.9 % ) in the no oral treatment group ( P = 0.29 ) . At the 2-week follow-up visit , 6/31 ( 19.4 % ) women had a positive UC in the oral therapy compared to 8/26 ( 30.1 % ) in the no oral treatment group but this difference was not statistically significant ( P = 0.31 ) . Conclusions : Completion of 10 days of antibiotic therapy with oral medication does not significantly reduce the risk of recurrent pyelonephritis immediately post-parenteral treatment . Women in the no oral treatment group had a non-significant increase in positive UC at the 2-week follow-up visit . The high rates of recurrent urinary tract infection during pregnancy in both groups underscore the need for regular UC and for the possible role of oral antibiotic suppression Acute pyelonephritis remains a frequent complication of pregnancy . Prevention of the potential complications of this disease requires aggressive in-hospital management . However , the high frequency of positive outpatient cultures following discharge has cast doubt on the adequacy of in-hospital care and , at the same time , has concentrated attention on follow-up care . In a r and omized , prospect i ve study , we evaluated the effects of in-hospital management and outpatient nitrofurantoin  on subsequent urine cultures . The overall frequency of positive cultures following discharge from the hospital was 38 % . However , appropriate antibiotic selection , a negative follow-up in-hospital culture and nitrofurantoin suppression reduced the rate to 8 % ( P less than .01 ) . Nitrofurantoin did not reduce the rate of positive cultures if antibiotic selection was inappropriate or if the in-hospital follow-up culture was positive . These results suggest that more aggressive management of acute pyelonephritis in pregnancy may be indicated and that suppressive therapy can not compensate for inappropriate in-hospital management Urinary tract infection ( UTI ) is a common complication of pregnancy . Approximately 20 - -40 % of women with asymptomatic bacteriuria will develop pyelonephritis during pregnancy . All pregnant women , therefore , should have their urine cultured at their first visit to the clinic . In a clinical study comparing single-dose treatment with 3 g fosfomycin trometamol versus a 3-day course of 400 mg ceftibuten orally , the inclusion criteria were acute symptomatic lower UTI ( acute cystitis ) , significant bacteriuria ( > or = 10(3 ) CFU/ml ) , pyuria and confirmed pregnancy . Excluded were patients with asymptomatic bacteriuria or acute pyelonephritis . Predisposing factors comprised a history of recurrent UTI , diabetes mellitus , analgesic nephropathy , hyperuricaemia or Fanconi 's syndrome . Escherichia coli was the most frequently isolated pathogen in both groups . Therapeutic success ( clinical cure and bacteriological eradication of uropathogens ) was achieved in 95.2 % of the patients treated with fosfomycin-trometamol versus 90.0 % of those treated with ceftibuten ( P , non-significant ) . The treatment of acute cystitis in pregnant women using a single-dose of fosfomycin trometamol was equally effective as the 3-day course of oral ceftibuten . Both regimens were well tolerated with only minor adverse effects . Long-term chemoprophylaxis should be suggested in patients with recurrent UTI or following acute pyelonephritis during pregnancy Today , it is widely accepted that a short-course or single-dose treatment with antimicrobial agents in pregnancy is the optimal therapy to minimize the risk of toxicity both for the mother and the fetus . A r and omized trial comparing single-dose ( 3 g ) treatment with fosfomycin trometamol ( FT ) versus pipemidic acid ( 200-gram doses b.i.d . for 7 days ) in bacteriuric pregnant women is presented . The preliminary results show that single-dose FT has the same cure effect as conventional therapy with pipemidic acid A prospect i ve study was carried out in 103/863 obstetric patients with cystitis characterized by urinary urgency and frequency , dysuria , pyuria and suprapubic discomfort in the absence of systemic symptoms such as fever and costovertebral angle tenderness . The association of symptomatic lower urinary tract infection with low-count bacteriuria ( 10(2)-10(5 ) UFC/mL of urine ) was present in all the patients . The incidence of cystourethritis was about 12 % , most of the infections occurred at the first trimester . To learn whether a multiple-dose of nitrofurantoin or ampicillin is safe and effective therapy for acute uncomplicated urinary tract infections , 103 symptomatic pregnant women were r and omly grouped to receive oral nitrofurantoin ( 100 mg t.i.d . ) or ampicillin ( 500 mg t.i.d . ) for five days . Seventeen patient were excluded since they did not return for follow-up .  Escherichia coli was isolated in 67 % of infections . Overall cure varied from 87 % to 89 % , without any great differences between the regimens . Nine patients had asymptomatic bacteriuria in the course of pregnancy , four developed acute pyelonephritis and one of them had abnormal intravenous pyelogram OBJECTIVE The purpose of this study was to compare the efficacy of a single daily dose of intravenous ceftriaxone with that of multiple-dose cefazolin in the treatment of acute pyelonephritis in pregnancy . STUDY DESIGN This was a double-blind , r and omized , clinical trial . Patients admitted to the hospital with the diagnosis of acute pyelonephritis in pregnancy were enrolled and r and omized according to a computer-generated r and omization schedule . The study group received a single daily 1 gm dose of ceftriaxone intravenously along with two additional doses of normal saline solution . The comparison group received three daily 2 gm doses of cefazolin intravenously . All infusions were given on an 8-hour schedule . Treatments were continued until the patient became afebrile . Each patient was discharged from the hospital on a regimen of appropriate oral antibiotics as directed by urine culture and sensitivities . At follow-up visits test-of-cure cultures were obtained . RESULTS During the 2-year study period , 178 patients were r and omized : 88 received cefazolin and 90 ceftriaxone . Patient demographics and presenting signs and symptoms were similar in both groups . No differences were noted between the groups regarding days of febrile morbidity , length of hospital stay , or treatment failures . CONCLUSIONS Daily single-dose intravenous ceftriaxone is as effective as multiple-dose cefazolin in the treatment of patients with acute pyelonephritis during pregnancy Ninety pregnant women admitted to the high-risk pregnancy unit with a diagnosis of acute pyelonephritis were r and omized to receive either oral ( cephalexin 500 mg every 6 hours ) or intravenous ( IV ) ( cephalothin 1 g every 6 hours ) antibiotic therapy . All patients were initially hydrated with 1 L of normal saline IV over 4 hours . Neither parenteral analgesics nor antiemetics were used . Bacteremia was noted in 13 ( 14.4 % ) of the 90 patients and m and ated IV therapy . There was no difference between the oral and IV groups concerning predefined criteria for successful therapy ( 91.4 versus 92.9 % successful therapy , respectively ) . No characteristic available at presentation predicted bacteremia or ultimate failure of therapy . Two patients ( 2.2 % ) experienced significant complications . These data suggest that in non-bacteremic patients , oral antibiotics are both safe and effective for the treatment of acute pyelonephritis in Summary . Ninety obstetric patients with significant bacteriuria were treated r and omly with either a single dose of 3 g amoxycillin or with a conventional course of ampicillin over 7 days . Treatment groups were comparable in terms of age , gravidity and socioeconomic status , and the outcome of pregnancy 
    Output:
    
REVIEW ER 'S CONCLUSIONS Although antibiotic treatment is effective for the cure of urinary tract infections , there are insufficient data to recommend any specific treatment regimen for symptomatic urinary tract infections during pregnancy .
All of the antibiotics studied were shown to be very effective in decreasing the incidence of outcomes measured .
Complications were very rare .