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Single dose treatment of cystitis in children
K J Lidefelt1, I Bollgren, A Wiman
1Department of Paediatrics, Karolinska Institute, Sachs Children's Hospital, Stockholm, Sweden.
Insights
A single dose of trimethoprim showed similar effectiveness to a 5-day course for treating urinary tract infections in children. Further research is needed to confirm if these treatment durations are equally effective long-term.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Urinary tract infections (UTIs) are common in children.
- Optimal antibiotic treatment duration for uncomplicated pediatric UTIs is an area of ongoing research.
- Trimethoprim is a frequently used antibiotic for UTIs.
Purpose of the Study:
- To compare the efficacy of a single-dose regimen of trimethoprim versus a 5-day course for treating symptomatic, non-febrile UTIs in children.
- To assess short-term cure rates and evaluate the impact of bacterial virulence factors (P-fimbriation) on treatment outcomes.
- To observe reinfection rates over a 6-month follow-up period.
Main Methods:
- A randomized study involving 100 children aged 3-12 years with isolated, symptomatic, non-febrile UTIs.
- Participants were assigned to either a single-dose trimethoprim treatment or a 5-day course of the same antibiotic.
- Cure was defined as sterile urine within one week post-treatment; follow-up for reinfections occurred over six months.
Main Results:
- Short-term cure rates were 74% for the single-dose group and 86% for the 5-day group.
- This difference in efficacy was not statistically significant (p = 0.134).
- Similar reinfection rates (six children in each group) were observed during the 6-month follow-up, irrespective of P-fimbriation status of E. coli.
Conclusions:
- Single-dose trimethoprim appears to be a potentially viable alternative to a 5-day course for treating uncomplicated pediatric UTIs, though not statistically superior in this study.
- Bacterial P-fimbriation did not significantly influence the comparative efficacy of the two treatment durations.
- Larger, extended studies are warranted to definitively establish the long-term equivalence of single-dose versus conventional multi-day trimethoprim therapy for pediatric UTIs.
Abstract:
The efficacy of single dose treatment with trimethoprim compared to a 5-day course with the same drug was investigated in 100 children, 3-12 years, with isolated episodes of symptomatic non-febrile urinary tract infection. Cure, defined as sterile urine during the first week after treatment, was achieved in 74% (37/50) in the single dose group compared to 86% (43/50) in the 5-day treatment group. The difference was not statistically significant (chi 2 = 2.25, p = 0.134 two-tailed). The cure rates in relation to P-fimbriation of the infecting E. coli strains were similar in the two groups. During the 6 month follow-up, six children in each treatment group had one or more reinfections. Extended studies are needed to conclude if single dose and conventional treatment courses are equally effective.