Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial
Giovanni Montini1,2, Antimo Tessitore3, Karen Console3
1Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milano, Italy.
Pediatrics
|December 26, 2023
Summary
A 5-day amoxicillin-clavulanate course effectively treats febrile urinary tract infections (fUTIs) in children, showing noninferiority to the standard 10-day regimen. This shorter treatment reduces recurrence rates and offers a potentially more convenient option for pediatric fUTI management.
Area of Science:
- Pediatric infectious diseases
- Antibiotic stewardship
- Clinical trial methodology
Background:
- Febrile urinary tract infections (fUTIs) in children are typically treated with 10-day oral antibiotics.
- Optimizing antibiotic duration is crucial for effective treatment and reducing resistance.
Purpose of the Study:
- To evaluate the noninferiority of a 5-day amoxicillin-clavulanate course versus a 10-day course for treating fUTIs in children.
- To assess recurrence rates, clinical recovery, and adverse events associated with shorter antibiotic durations.
Main Methods:
- A multicenter, randomized, controlled trial involving children aged 3 months to 5 years with uncomplicated fUTI.
- Participants received amoxicillin-clavulanate for either 5 or 10 days.
- Primary endpoint: fUTI recurrence within 30 days post-therapy.
Main Results:
- The 5-day group had a recurrence rate of 2.8% compared to 14.3% in the 10-day group.
- The recurrence rate of fUTI within 30 days was 1.4% in the short group and 5.7% in the standard group.
- The 5-day regimen demonstrated noninferiority to the 10-day regimen.
Conclusions:
- A 5-day course of oral amoxicillin-clavulanate is noninferior to a 10-day course for treating fUTIs in children.
- Shorter antibiotic durations may be a viable option for pediatric fUTI management.
- Further research could explore long-term outcomes and resistance patterns.
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