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Evidence summaries

Short Versus Standard Duration Oral Antibiotic Therapy for Acute Urinary Tract Infection in Children

A 2-4 day course of oral antibiotics is as effective as 7-14 days course in eradicating lower urinary tract infection (UTI) in children, but 10 days of therapy appears to be more effective than single-dose therapy. Level of evidence: "A"

A Cochrane review [Abstract] 1 included 16 studies with a total of 1 116 children. Conventional 10-day antibiotic treatment significantly increased the number of children free of persistent bacteriuria compared to single-dose therapy (RR 2.01, 95%CI 1.06 to 3.80; 6 studies, n=228 children). Persistent bacteriuria at the end of treatment was reported in 24% of children receiving single-dose therapy compared to 10% of children who were randomised to 10-day therapy. There were no significant differences between groups for persistent symptoms, recurrence following treatment, or re-infection following treatment. There was insufficient data to analyse the effect of antibiotics on renal parenchymal damage, compliance, development of resistant organisms or adverse events. There was no significant difference in persistent bacteriuria between single-dose and short-course (3 - 7 days) antibiotic treatment (RR 1.30, 95% CI 0.65 to 2.62; 2 studies, n=145 children). There was no significant difference in persistent bacteriuria between short-course (3-7 days) and long-course (7-10 days) antibiotic treatment (RR 1.09, 95% CI 0.67 to 1.76; 3 studies, n=265).

A Cochrane review [Abstract] 1 included 10 studies with a total of 652 children. There was no significant difference in the frequency of positive urine cultures between the short (2-4 days) and standard duration oral antibiotic therapy (7-14 days) for UTI in children at 0-10 days after treatment (eight studies: RR 1.06; 95% CI 0.64 to 1.76) and at one to 15 months after treatment (10 studies: RR 0.95; 95% CI 0.70 to 1.29). There was no significant difference between short and standard duration therapy in the development of resistant organisms in UTI at the end of treatment (one study: RR 0.57, 95% CI 0.32 to 1.01) or in recurrent UTI (three studies: RR 0.39, 95% CI 0.12 to 1.29).

References

  • Fitzgerald A, Mori R, Lakhanpaul M et al. Antibiotics for treating lower urinary tract infection in children. Cochrane Database Syst Rev 2012;(8):CD006857. [PubMed]
  • Michael M, Hodson EM, Craig JC, Martin S, Moyer VA. Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children. Cochrane Database Syst Rev 2003;(1):CD003966. [PubMed]

Primary/Secondary Keywords