***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Urinary tract infections ( UTI ) can cause acute morbidity and may result in severe problems , including hypertension and reduced renal function . Diagnosis of UTI is extremely important since prompt treatment may prevent damage . In the present study we compared the efficacy of oral cefixime to initial intramuscular ceftizoxime followed by cefixime for the treatment of UTI in children . Fifty-four children were studied . They were r and omized to receive either oral cefixime 8 mg/kg/day for 10 days or initial intramuscular ceftizoxime ( Cefızox ) 50 mg/kg twice a day for 2 days followed by oral cefixime for 8 days . Treatment groups were comparable regarding age , sex , clinical , and laboratory findings . Escherichia coli was isolated from 80 % of patients . Repeat urine cultures were sterile within 24 hours in all children . Cure rates were comparable in both groups ( 92 % vs 86 % at the end of treatment ) . No serious adverse effects were observed . We concluded that oral cefixime is a safe and effective alternative treatment Background . The st and ard recommendation for treatment of young , febrile children with urinary tract infection has been hospitalization for intravenous antimicrobials . The availability of potent , oral , third-generation cephalosporins as well as interest in cost containment and avoidance of nosocomial risks prompted evaluation of the safety and efficacy of outpatient therapy . Methods . In a multicenter , r and omized clinical trial , we evaluated the efficacy of oral versus initial intravenous therapy in 306 children 1 to 24 months old with fever and urinary tract infection , in terms of short-term clinical outcomes ( sterilization of the urine and defervescence ) and long-term morbidity ( incidence of reinfection and incidence and extent of renal scarring documented at 6 months by99mTc-dimercaptosuccinic acid renal scans ) . Children received either oral cefixime for 14 days ( double dose on day 1 ) or initial intravenous cefotaxime for 3 days followed by oral cefixime for 11 days . Results . Treatment groups were comparable regarding demographic , clinical , and laboratory characteristics . Bacteremia was present in 3.4 % of children treated orally and 5.3 % of children treated intravenously . Of the short-term outcomes , 1 ) repeat urine cultures were sterile within 24 hours in all children , and 2 ) mean time to defervescence was 25 and 24 hours for children treated orally and intravenously , respectively . Of the long-term outcomes , 1 ) symptomatic reinfections occurred in 4.6 % of children treated orally and 7.2 % of children treated intravenously , 2 ) renal scarring at 6 months was noted in 9.8 % children treated orally versus 7.2 % of children treated intravenously , and 3 ) mean extent of scarring was ∼8 % in both treatment groups . Mean costs were at least twofold higher for children treated intravenously ( $ 3577 vs $ 1473 ) compared with those treated orally . Conclusions . Oral cefixime can be recommended as a safe and effective treatment for children with fever and urinary tract infection . Use of cefixime will result in substantial reductions of health care expenditures Abstract . The aim of this study was to compare , in children with acute pyelonephritis , the efficacy of 7 days ’ ( group A ) and 3 days ’ ( group B ) intravenous antibiotics , both followed by an oral treatment . Children were r and omized after 3 days of intravenous treatment . Technetium-99 m dimercaptosuccinic acid ( DMSA ) scintigraphy was performed within the first days after admission and repeated 6 months later . Total or partial persistence of renal abnormalities on the 6-month DMSA scintigraphy was used as the endpoint of the study . Among the 92 children included in the study , 87 were followed for at least 6 months ( 43 in group A and 44 in group B ) and were eligible for analysis .  Late DMSA was abnormal in 9 kidneys of group A and 12 kidneys of group B , representing respectively 24 % and 44 % of kidneys with abnormalities on the initial DMSA ( difference statistically not significant ) . When the patients were stratified according to the delay of treatment , the percentage of patients with sequelae in group A was comparable , whether the delay was less or more than 1 week . In group B , the percentage of patients with sequelae was significantly higher ( P<0.01 ) when the delay was more than 1 week Objective . To undertake population pharmacokinetic modeling and to determine the safety and efficacy of once daily ( OD ) gentamicin dosing in children with severe urinary tract infections ( UTI ) . Methods . An open , r and omized , controlled trial comparing OD with three times daily ( TD ) gentamicin dosing in hospitalized children ages 1 month to 12 years with UTI . Daily doses ( milligrams per kg per day ) of gentamicin in both groups were 7.5 ( < 5 years old ) , 6.0 ( 5 to 10 years old ) and 4.5 ( > 10 years old ) . Results . There were 179 children enrolled ( 90 OD , 89 TD ) . Baseline clinical characteristics and pathogens were similar , except that circulatory compromise and renal cortical scintigraphic defects were more common in the OD group . Median gentamicin treatment duration s were 3.0 ( OD ) and 2.7 ( TD ) days . Mean peak gentamicin concentrations were 17.3 ( OD ) vs. 6.4 ( TD ) mg/l ; 99 % of peak concentrations were > 7 mg/l in the OD group whereas 16 % of peak concentrations were < 5 mg/l in the TD group . Mean trough concentrations were 0.35 ( OD ) vs. 0.55 ( TD ) mg/l . In the OD group 4 % of trough concentrations were ≥2 mg/l , whereas in the TD group only 0.7 % were ≥2 mg/l . Age or prior elevated peak concentrations did not predict high trough concentrations . Population pharmacokinetic modeling of the data fitted a one-compartment model with first order elimination . There were no clinical or bacteriologic failures . The two disease-related complications were confined to the OD group . No nephro- or ototoxicity was identified . Conclusions . With age-appropriate dosing and measurement of serum trough concentrations before the second dose , OD gentamicin is safe and effective for the treatment of UTI requiring parenteral treatment in children aged 1 month to 12 years The efficacy and safety of netilmicin , 5 mg/kg of body weight once daily or 2 mg/kg thrice daily for 10 days , for the treatment of gram-negative pyelonephritis in children were compared in a prospect i ve , r and omized trial . Explicit criteria were used to define the site of infection , treatment outcome , and adverse effects . Netilmicin was given to 74 children once daily and to 70 children three times daily . At 1 week posttreatment , 73 ( 99 % ) of 74 children treated with netilmicin once daily and 70 ( 100 % ) of 70 children treated with netilmicin three times daily were cured . At 4 weeks posttreatment , no relapse was detected and the rate of reinfection was essentially identical in the two treatment groups . Peak serum netilmicin concentrations were higher in patients given the once-daily regimen , whereas a higher trough level was detected in patients given the three-times-daily regimen . Nephrotoxicity , which was defined as an increase in the serum creatinine level of greater than or equal to 0.3 mg/dl over the baseline , was rare ( 3 % ) and reversible and occurred regardless of the treatment regimen . Ototoxicity , which was assessed by pure-tone audiometry ( 250 to 8,000 Hz ) and brain stem-evoked response ( 6,000 Hz ) , occurred in 2 of 32 children who were evaluated . In these two children , who were given the once-daily regimen , wave V was not evokable monolaterally below 25 and 40 dB normal hearing level , respectively . Thus , it may be possible to treat childhood pyelonephritis with netilmicin once daily . However , this new approach needs to be confirmed in other studies Aim : To examine the safety and efficacy of once‐daily ( OD ) gentamicin treatment compared with conventional 8‐hourly dosing ( TDS ) for urinary tract infection ( UTI ) . Methods : This was a prospect i ve , r and omized , controlled trial of children 1 mo to 13 y of age with presumed UTI . Children were r and omly assigned to OD gentamicin 5 mg kg−1 d−1 or TDS gentamicin 6 mg kg−1 d−1 divided 8 hourly  . Microbiological efficacy , nephrotoxicity , ototoxicity and renal scarring were assessed at the end of treatment . Results : 210 patients with presumed UTI were recruited , of whom 172 were analysable ( OD 84 , TDS 88 ) . The median age was 7 mo , 50 % were male and 74 % ( n= 127 ) of patients had pyelonephritis . The majority of infections were due to Escherichia coli ( n= 153 , 89 % ) , of which 9 ( 5.2 % ) were bacteraemic . Comparing the two groups , there was no significant difference in age , gender , duration of fever before admission , pyuria , nitrite positivity or initial total white blood cell count . All patients had negative urine cultures after 2–3 d of treatment , demonstrating 100 % microbiological efficacy . There was no difference between the two groups in terms of ototoxicity , nephrotoxicity , duration of gentamicin treatment or time to fever defervescence BACKGROUND Acute pyelonephritis often leaves children with permanent renal scarring . AIMS To compare the prevalence of scarring following initial treatment with antibiotics administered intravenously for 10 or three days . METHODS In a prospect i ve two centre trial , 220 patients aged 3 months to 16 years with positive urine culture and acute renal lesions on initial DMSA scintigraphy , were r and omly assigned to receive intravenous ceftriaxone ( 50 mg/kg once daily ) for 10 or three days , followed by oral cefixime ( 4 mg/kg twice daily ) to complete a 15 day course . After three months , scintigraphy was repeated in order to diagnose renal scars . RESULTS Renal scarring developed in 33 % of the 110 children in the 10 day intravenous group and 36 % of the 110 children in the three day group . Children older than 1 year had more renal scarring than infants ( 42 % ( 54/129 ) and 24 % ( 22/91 ) , respectively ) . After adjustment for age , sex , duration of fever before treatment , degree of inflammation , presence of vesicoureteric reflux , and the patients ' recruitment centres , there was no significant difference between the two treatments on renal scarring . During follow up , 15 children had recurrence of urinary infection with no significant difference between the two treatment groups . CONCLUSION In children with acute pyelonephritis , initial intravenous treatment for 10 days , compared with three days , does not significantly reduce the development of renal scarring Abstract To investigate the attitude of Belgian pediatricians toward the management and treatment of children with suspected acute pyelonephritis , a short letter was sent to all Belgian pediatricians ( 1200 ) . It contained a brief description of a clinical case strongly suggestive of acute pyelonephritis followed by a series of questions centered on complementary examinations to be performed , need of hospitalization and treatment . A total of 583 responses were received ( 49 % ) . In the acute phase , 99 % of pediatricians perform urine cultures , 87 % blood examinations , and 76 % renal ultrasound .  Dimercaptosuccinate ( DMSA ) scintigraphy  is performed during the acute phase by 37 % and during follow-up by 32 % of all pediatricians . A voiding cystogram is requested by 71 % . Ambulatory treatment is considered by 30 % of responders . Amoxicillin/clavulanic acid ( 44 % ) and trimethoprim/sulfonamide ( 22 % ) are the most frequently used oral antibiotics . Private pediatricians perform fewer examinations and more frequently consider ambulatory treatment of acute pyelonephritis , compared to pediatricians working in hospitals . Among Belgian pediatricians , attitudes toward the diagnosis and treatment of acute pyelonephritis are heterogeneous . This survey underlines the need for properly documented prospect i ve studies for the evaluation of different treatment modalities in childhood acute pyelonephritis Cefetamet pivoxil was investigated in an open , r and omized comparative study involving a total of 37 children with acute pyelonephritis , whose ages ranged from 2 to 14 years . The patients received either 10 mg/kg ( n = 18 ) or 20 mg/kg ( n = 8) cefetamet pivoxil twice daily , or 30–50 mg/kg amoxycillin/clavulanic acid three times daily ( n = 1 
    Output:
    
These results suggest that children with acute pyelonephritis can be treated effectively with oral antibiotics ( cefixime , ceftibuten and amoxycillin/clavulanic acid ) or with short courses ( 2 to 4 days ) of IV therapy followed by oral therapy .
If IV therapy is chosen , single daily dosing with aminoglycosides is safe and effective .