Short-Course Therapy for Urinary Tract Infections in Children: The SCOUT Randomized Clinical Trial.

Area of Science:

• Pediatric infectious diseases
• Antimicrobial stewardship
• Clinical trial methodology

Background:

• Limited pediatric-specific data exists for optimal urinary tract infection (UTI) treatment duration.
• Current guidelines often lack comparative efficacy data for varying antimicrobial therapy lengths in children.

Purpose of the Study:

• To compare the efficacy of standard-course (10 days) versus short-course (5 days) antimicrobial therapy for pediatric UTI.
• To evaluate treatment failure and secondary outcomes in children with UTI receiving different therapy durations.

Main Methods:

• A randomized clinical noninferiority trial (SCOUT) involving children aged 2 months to 10 years with UTI.
• Participants received either 5 additional days of antimicrobials (standard) or 5 days of placebo (short) after initial 5-day treatment.
• Primary outcome was symptomatic UTI at first follow-up (day 11-14); secondary outcomes included later UTI, positive cultures, and resistant organism colonization.

Main Results:

• Treatment failure occurred in 0.6% of the standard-course group vs. 4.2% of the short-course group.
• Children on short-course therapy had higher rates of asymptomatic bacteriuria or positive urine culture.
• No significant differences were observed in post-first follow-up UTI rates, adverse events, or resistant organism colonization.

Conclusions:

• Standard-course antimicrobial therapy demonstrated a lower rate of treatment failure compared to short-course therapy in pediatric UTI.
• Short-course therapy, with its low failure rate, may be a reasonable consideration for children with UTI who show clinical improvement after 5 days of treatment.