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Short- versus standard-course antibiotic therapy for urinary tract infection in children: a systematic review and
Andressa A Noronha1, Gabrielle R Domingues2, Gabriela C de Souza2
1Department of Pediatrics, University of São Paulo, 647 Dr. Enéas de Carvalho de Aguiar Av, São Paulo, 05403000, Brazil. andressa.noronha@hc.fm.usp.br.
Insights
A short course of antibiotics may be suitable for children with afebrile urinary tract infections (UTIs). However, more research is needed to determine the optimal antibiotic duration for febrile UTIs in pediatric patients.
Area of Science:
- Pediatric infectious diseases
- Clinical pharmacology
- Evidence-based medicine
Background:
- Urinary tract infections (UTIs) are common in children, posing a significant healthcare challenge.
- Antibiotic treatment is standard, but optimal duration is not well-established.
Purpose of the Study:
- To systematically review and perform a meta-analysis on the optimal antibiotic therapy duration for pediatric UTIs.
- To compare short-course (2-5 days) versus standard-course (≥7 days) antibiotic treatments.
Main Methods:
- Systematic search of MEDLINE, Embase, and Cochrane Library databases.
- Inclusion of randomized controlled trials (RCTs) in patients under 18 years.
- Meta-analysis using a random-effects model to calculate risk ratios and mean differences.
Main Results:
- 12 RCTs with 1442 children were analyzed.
- Short-course antibiotics showed no significant difference in cure rates for afebrile UTIs or recurrence.
- A trend favoring longer treatment for febrile UTIs was observed, but with high heterogeneity.
Conclusions:
- Short-course antibiotic therapy appears feasible for afebrile UTIs in children.
- Further research is necessary to establish optimal treatment durations for febrile UTIs.
- Limitations include moderate heterogeneity and a small subgroup of children with urinary tract abnormalities.
Background:
Urinary tract infections are prevalent among children and are responsible for a significant healthcare burden. Antibiotic therapy is the cornerstone of treatment, but the optimal treatment duration remains elusive.
Objectives:
This systematic review and meta-analysis aimed to explore the optimal duration of antibiotic therapy for urinary tract infection (UTI) in pediatric patients.
Data Sources:
A comprehensive search was performed, including MEDLINE, Embase, and Cochrane Library databases.
Study Eligibility Criteria:
We included only randomized controlled trials (RCTs) comparing short-course (2 to 5 days) and standard-course (≥ 7 days) antibiotic treatment in patients < 18 years of age.
Study Appraisal And Synthesis Methods:
We performed this systematic review and meta-analysis following Cochrane Collaboration recommendations using a random-effects model. Effect estimate was calculated using the risk ratio (RR) with 95% confidence interval (95% CI) for dichotomous and mean difference (MD) with 95% CI for continuous endpoints. Significance was regarded at p-value < 0.05. Statistical analysis was performed using Review Manager 5.4.1.
Results:
Data from 12 RCTs, encompassing 1442 children, were included. Follow-up ranged from 1 to 12 months. The mean age was 5.9 years, with approximately 87% female patients. E. coli was the most common pathogen isolated from urine cultures. There was a significant difference in cure rates (RR 0.97; 95% CI 0.95-0.99; p = 0.01) between the groups when only studies that included febrile UTI were analyzed together, favoring 7 days or more of treatment, but with high heterogeneity. Otherwise, there was no significant difference in cure rates (RR 0.99; 95% CI 0.91-1.08; p = 0.80) in children with afebrile UTI or recurrence of UTI at any time in children with afebrile (RR 0.98; 95% CI 0.84-1.15; p = 0.80) or febrile UTI (RR 0.52; 95% CI 0.10-2.83; p = 0.45). Also, there was no significant difference in failure rates in children with urinary tract abnormalities and afebrile UTI (RR 0.79; 95% CI 0.47-1.32; p = 0.36), between the short- and the standard-course treatment groups.
Limitations:
This analysis was limited by the moderate heterogeneity and the small subgroup of children with urinary tract abnormalities, which could have underpowered our results.
Conclusions And Implications Of Key Findings:
The primary outcome of this analysis suggests that a short course of antibiotic therapy is feasible in children with afebrile UTI, but more studies are warranted to safely establish an optimal treatment duration for children with febrile UTI.
Systematic Review Registration Number:
The study protocol was registered in the PROSPERO platform under the number CRD42023489094.
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