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Short Intravenous Antibiotic Courses for Urinary Infections in Young Infants: A Systematic Review
Samar Hikmat1, Jolie Lawrence2, Amanda Gwee2,3,4
1Faculty of Medicine, Dentistry, and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
Insights
Shorter intravenous (IV) antibiotic courses for infant urinary tract infections (UTIs) are effective. For bacteremic UTIs, 7 days or less is suitable. For non-bacteremic UTIs, 3 days or less with oral antibiotics is recommended.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Urinary tract infections (UTIs) are common in young infants.
- Current treatment guidelines lack optimal duration for intravenous (IV) antibiotic therapy in infants.
Purpose of the Study:
- To evaluate the appropriateness of shorter IV antibiotic durations (≤7 days) for managing UTIs in infants up to 90 days old.
Main Methods:
- A systematic review of PubMed, Cochrane Library, Medline, and Embase databases up to February 2021.
- Included studies focused on infants ≤90 days with UTIs, short IV antibiotic durations, and treatment outcomes.
- Study screening and bias assessment followed PRISMA, Newcastle-Ottawa Scale, and Revised Cochrane Risk-of-Bias Tool guidelines.
Main Results:
- Eighteen studies involving 16,615 infants were analyzed.
- No difference in 30-day recurrence for bacteremic UTI with ≤7 vs >7 days of IV antibiotics.
- No significant difference in 30-day recurrence for non-bacteremic UTI with ≤3 vs >3 days of IV antibiotics.
Conclusions:
- Shorter IV antibiotic courses (≤7 days for bacteremic, ≤3 days for non-bacteremic UTI) are viable for infants ≤90 days, with early switch to oral antibiotics.
- Meningitis must be excluded before considering shorter courses.
- Further research on oral antibiotic monotherapy for this age group is warranted.
Context:
Urinary tract infections (UTIs) are common in young infants, yet there is no guidance on the optimal duration of intravenous (IV) treatment.
Objective:
To determine if shorter IV antibiotic courses (≤7 days) are appropriate for managing UTIs in infants aged ≤90 days.
Methods:
PubMed, the Cochrane Library, Medline, and Embase (February 2021) were used as data sources. Included studies reported original data for infants aged ≤90 days with UTIs, studied short IV antibiotic durations (≤7 days), and described at least 1 treatment outcome. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Studies were screened by 2 investigators, and bias was assessed by using the Newcastle-Ottawa Scale and the Revised Cochrane Risk-of-Bias Tool.
Results:
Eighteen studies with 16 615 young infants were included. The largest 2 studies on bacteremic UTI found no difference in the rates of 30-day recurrence between those treated with ≤7 vs >7 days of IV antibiotics. For nonbacteremic UTI, there was no significant difference in the adjusted 30-day recurrence between those receiving ≤3 vs >3 days of IV antibiotics in the largest 2 studies identified. Three studies of infants aged ≥30 days used oral antibiotics alone and reported good outcomes, although only 85 infants were ≤90 days old.
Conclusions:
Shorter IV antibiotic courses of ≤7 days and ≤3 days with early switch to oral antibiotics should be considered in infants aged ≤90 days with bacteremic and nonbacteremic UTI, respectively, after excluding meningitis. Further studies of treatment with oral antibiotics alone are needed in this age group.
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