Short-Course Versus Standard-Course Antibiotics for Neonatal Urinary Tract Infection: Implications for Urological...

This study aimed to compare the effects of short-course (5-7 days) versus standard-course (10-14 days) antibiotics on the incidence and recurrence of renal cortical defects and urological management outcomes in neonates with urinary tract infection (UTI), particularly in those with underlying urinary malformations.

A retrospective analysis was conducted on 196 neonates with UTIs (98 in the short-course group and 98 in the standard-course group) admitted to our centre between February 2021 and December 2024. The co-primary outcomes were the incidence of renal cortical defects on Technetium-99m dimercaptosuccinic acid (99mTc-DMSA) imaging at 6-12 months and 30-day UTI recurrence. Prespecified secondary outcomes included treatment-related indicators, short-term efficacy, renal function, safety and health-economic endpoints. Structural follow-up, urological referral, urological intervention and subgroup outcomes according to urinary malformation status were analysed as exploratory outcomes. Subsequently, 1:1 propensity score matching was performed to mitigate confounding by indication.

The short-course group had a significantly shorter antibiotic duration and hospital stay, with lower total hospitalisation and antibiotic costs (all p < 0.001), than the standard-course group. 30-day UTI recurrence was higher in the short-course group than in the standard-course group, whereas the incidence of renal cortical defects at 6-12 months did not differ significantly. Structural follow-up and urological subgroup findings, particularly in neonates with urinary malformations, showed nominal between-group differences but were interpreted as exploratory after correction for multiple comparisons.

In this single-centre retrospective cohort study, short-course antibiotics yielded comparable renal cortical defect outcomes but a higher 30-day UTI recurrence rate compared with standard-course antibiotics in neonates with UTIs. Short-course therapy was associated with shorter hospitalisation and lower overall costs than standard-course therapy. Structural and urological follow-up findings, particularly in neonates with urinary malformations, should be interpreted as exploratory and require prospective validation.