Shorter courses of antimicrobial therapy for bacterial infections may help reduce antimicrobial resistance, adverse effects of therapy, costs of therapy, and long-term adverse impacts on the host microbiome. Current guidelines in the United States and Europe recommend 7 to 14 days of therapy for urinary tract infection (UTI) in children.
Febrile urinary tract infection (fUTI) in children who appear well is usually treated with a 10-day course of oral antibiotics. However, a recent study published in the Journal of Pediatrics found that a 5-day course of amoxicillin-clavulanate is just as effective as the standard 10-day regimen for treating fUTIs. The study met the noninferiority threshold of 5%.
The multicenter, investigator-initiated, parallel-group, randomized, controlled trial conducted by Montini et al. Involved children aged 3 months to 5 years with noncomplicated fUTI. The subjects were randomly assigned to receive amoxicillin-clavulanate 50 + 7.12 mg/kg/day orally in 3 divided doses for either 5 or 10 days. The primary endpoint was the recurrence of a UTI within 30 days post-therapy. Secondary endpoints included differences in clinical recovery prevalence, adverse drug-related events, and resistance to amoxicillin-clavulanic acid and/or other antibiotics in cases of recurrent infection. The recurrence rate within 30 days post-therapy was 2.8% (2/72) in the short group and 14.3% (10/70) in the standard group. The difference between the two groups was -11.51% (95% confidence interval, -20.54 to -2.47). The recurrence rate of febrile urinary tract infection within 30 days from therapy completion was 1.4% (1/72) in the short group and 5.7% (4/70) in the standard group (95% confidence interval, -10.4 to 1.75).
According to Montini et al., there is no significant difference between the two treatments regarding clinical cure rates, recurrence of infection within 30 days after therapy, adverse events, and development of antibiotic resistance. It is important to note that decisions on the duration of antibiotic therapy should be guided by evidence-based practices and tailored to the specific clinical scenario.
Reference
Montini G, Tessitore A, Console K, Ronfani L, Barbi E, Pennesi M, et al. Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial. Pediatrics. 2023 Dec 26; e2023062598.