***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 Objective To compare the efficacy of oral antibiotic treatment alone with treatment started parenterally and completed orally in children with a first episode of acute pyelonephritis . Design Multicentre , r and omised controlled , open labelled , parallel group , non-inferiority trial . Setting 28 paediatric units in north east Italy . Participants 502 children aged 1 month to < 7 years with clinical pyelonephritis . Intervention Oral co-amoxiclav ( 50 mg/kg/day in three doses for 10 days ) or parenteral ceftriaxone ( 50 mg/kg/day in a single parenteral dose ) for three days , followed by oral co-amoxiclav ( 50 mg/kg/day in three divided doses for seven days ) . Main outcomes measures Primary outcome was the rate of renal scarring . Secondary measures of efficacy were time to defervescence ( < 37 � C ) , reduction in inflammatory indices , and percentage with sterile urine after 72 hours . An exploratory subgroup analysis was conducted in the children in whom pyelonephritis was confirmed by dimercaptosuccinic acid ( DMSA ) scintigraphy within 10 days after study entry . Results Intention to treat analysis showed no significant differences between oral ( n=244 ) and parenteral ( n=258 ) treatment , both in the primary outcome ( scarring scintigraphy at 12 months 27/197 ( 13.7 % ) v 36/203 ( 17.7 % ) , difference in risk −4 % , 95 % confidence interval −11.1 % to 3.1 % ) and secondary outcomes ( time to defervescence 36.9 hours ( SD 19.7 ) v 34.3 hours ( SD 20 ) , mean difference 2.6 ( −0.9 to 6.0 ) ; white cell count 9.8 � 109/l ( SD 3.5 ) v 9.5 � 109/l ( SD 3.1 ) , mean difference 0.3 ( −0.3 to 0.9 ) ; percentage with sterile urine 185/186 v 203/204 , risk difference −0.05 % ( −1.5 % to 1.4 % ) ) . Similar results were found in the subgroup of 278 children with confirmed acute pyelonephritis on scintigraphy at study entry . Conclusions Treatment with oral antibiotics is as effective as parenteral then oral treatment in the management of the first episode of clinical pyelonephritis in children . Trial registration Clinical Trials NCT00161330 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 Urinary tract infection in children is usually treated with orally administered antibiotics for 10 to 14 days . Because of the unreliability of patient compliance with prescribed medications and because single-dose aminoglycoside therapy has been shown to be effective in women with cystitis , we assessed the efficacy of single-dose amikacin for treatment of first episodes of Escherichia coli lower urinary tract infection in girls . Upper and lower urinary tract infections were presumptively differentiated by simple criteria such as clinical symptoms , fever , and erythrocyte sedimentation rate . Fifty-four girls ( ages 1 to 12 years ) with two positive urine cultures ( greater than 10(5 ) CFU/ml E. coli ) were assigned by a table of r and om numbers to receive treatment with either sulfisoxazole 150 mg/kg/day orally for 10 days or a single dose of amikacin 7.5 mg/kg intramuscularly . Six of 23 patients ( 26 % ) in the amikacin group and four of 21 ( 19 % ) in the sulfisoxazole group had at least one positive urine culture within 40 days after completion of therapy . This difference was not statistically significant ( P greater than 0.5 ) . This suggests that a single dose of amikacin is as effective as a 10-day course of sulfisoxazole in the treatment of presumed first lower urinary tract infection in girls . Additional potential advantages of single-dose therapy are fewer side effects and less toxicity , excellent compliance , and reduced potential for selecting resistant organisms 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 OBJECTIVES . To evaluate the role of primary vesicoureteral reflux ( VUR ) in increasing the frequency and severity of urinary tract infections ( UTIs ) and renal parenchymal damage among patients with acute pyelonephritis and to determine whether urinary antibiotic prophylaxis reduces the frequency and /or severity of UTIs and /or prevents renal parenchymal damage among patients with mild/moderate VUR . METHODS . Patients 3 months to 18 years of age with acute pyelonephritis , with or without VUR , were assigned r and omly to receive urinary antibiotic prophylaxis or not . Patients were monitored every 3 months for 1 year . Dimercaptosuccinic acid renal scans were repeated at 6 months or if there was a recurrence of febrile UTI . Urinalysis and urine culture were performed at each clinic visit . Renal ultrasound scans and voiding cystourethrograms were repeated at the end of 1 year of follow-up monitoring . RESULTS . Of the 236 patients enrolled in the study , 218 completed the 1-year follow-up monitoring . Groups were similar with respect to age , gender , and reflux grade distribution for those with VUR . No statistically significant differences were found among the groups with respect to rate of recurrent UTI , type of recurrence , rate of subsequent pyelonephritis , and development of renal parenchymal scars . CONCLUSIONS . After 1 year of follow-up monitoring , mild/moderate VUR does not increase the incidence of UTI , pyelonephritis , or renal scarring after acute pyelonephritis . Moreover , a role for urinary antibiotic prophylaxis in preventing the recurrence of infection and the development of renal scars is not supported by this study Forty-nine ambulatory children between 2 - 1/2 and 12 years of age with acute , clinical ly uncomplicated urinary tract infections caused by susceptible organisms were r and omized to receive a single dose of amoxicillin based on weight or a 10-day course of amoxicillin therapy ( conventional therapy ) . Patients receiving single doses of amoxicillin had a cure rate of 63 % , which compares unfavorably with the cure rate of 92 % in patients given conventional therapy . A failure of single-dose therapy predicted underlying radiologic abnormalities with a sensitivity of 60 % and a specificity of 58 % , making it a poor screening test for detecting those patients at risk for renal parenchymal damage . The antibody-coated bacteria assay had no predictive value in separating upper and lower tract disease , although it may predict underlying radi 
    Output:
    
These results suggest that children with acute pyelonephritis can be treated effectively with oral cefixime or with short courses ( 2 - 4 days ) of IV therapy followed by oral therapy .
If IV therapy is chosen , single daily dosing with aminoglycosides is safe and effective .