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Shorter- vs. longer-course antibiotics in children with acute uncomplicated UTIs: a systematic review and
Ming Liu1, Qi Wang2, PeiJing Yan3
1Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore.
Insights
Shorter antibiotic courses (2-5 days) for pediatric urinary tract infections (UTIs) show similar efficacy and safety to longer courses (≥7 days). Further research is needed for specific subgroups like infants and recurrent UTI cases.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
Background:
- Urinary tract infections (UTIs) are common in children.
- Standard treatment involves 7-14 days of antibiotics, but shorter durations are being explored.
Purpose of the Study:
- To compare the efficacy and safety of shorter-course (2-5 days) versus longer-course (≥7 days) antibiotic therapy for acute uncomplicated UTIs in children.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials.
- Included 13 trials with 2,010 children aged 2 months to 18 years.
- Assessed risk of bias using RoB 2.0 and certainty of evidence with GRADE framework.
Main Results:
- Shorter courses showed no significant difference in relapse or reinfection rates compared to longer courses.
- Bacteriological and clinical cure rates were similar between shorter and longer antibiotic regimens.
- No significant difference in adverse events was observed between the two treatment durations.
Conclusions:
- Shorter-course antibiotic therapy appears comparable to longer-course therapy for acute uncomplicated UTIs in children.
- Optimal duration may vary for specific subgroups, including infants and children with recurrent UTIs or fever, warranting further investigation.
Background:
Urinary tract infections (UTIs) are common in children, and longer antibiotic therapy typically lasts 7∼14 days. However, the efficacy and safety of shorter-course regimens remain uncertain.
Objectives:
To compare shorter-course (2∼5 days) vs. longer-course (≥7 days) antibiotic therapy for children with acute uncomplicated UTIs.
Methods:
A systematic review and meta-analysis was conducted.
Data Sources:
We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Embase from inception to 3 October 2025.
Study Eligible Criteria:
Randomized controlled trials.
Participants And Interventions:
Children (2 months to 18 years) with acute uncomplicated UTIs received longer-course (≥7 days) or shorter-course (2∼5 days) antibiotic therapy.
Assessment Of Risk Of Bias:
Two independent reviewers conducted Risk-of-Bias (RoB) assessments for each outcome using the RoB 2.0 tool.
Methods Of Data Synthesis:
Meta-analyses were performed using random-effects models. For all outcomes, we calculated risk ratio (RR) with 95% CIs. Absolute effects (risk difference [RD]) were calculated using RR and baseline risks, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.
Results:
Thirteen trials (15 data sets) involving 2010 children were included. High- or moderate-certainty evidence showed that shorter-course antibiotic therapy probably results in no difference in relapse rate (RR 1.08, 95% CIs 0.79-1.47; RD 8 more per 1000, 95% CIs 21 fewer to 47 more) and reinfection rate (RR 0.63, 95% CIs 0.38-1.03; RD 93 fewer per 1000, 95% CIs 156 fewer to 8 more), compared with longer-course. Low certainty evidence showed that, compared with longer-course antibiotic therapy, shorter-course antibiotic therapy may result in little or no difference in bacteriological cure rate (RR 0.96, 95% CIs 0.90-1.03; RD 36 fewer per 1000, 95% CIs 91 fewer to 27 more) and clinical cure rate (RR 0.99, 95% CIs 0.90-1.10; RD 10 fewer per 1000, 95% CIs 96 fewer to 96 more). Shorter-course antibiotic therapy probably (moderate-certainty) results in no difference in all adverse events, compared with longer-course (RR 0.93, 95% CIs 0.83-1.04; RD 5 fewer per 1000, 95% CIs 13 fewer to 3 more).
Conclusions:
For children with acute uncomplicated UTIs, a shorter-course antibiotic therapy appears comparable with the longer-course in terms of efficacy and safety. Further research is needed to define the optimal treatment duration for specific subgroups, particularly for population such as infants (2 months to 2 years) and children with recurrent UTIs or fever.
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