Duration of antibiotic treatment of urinary tract infections in children: a meta-analysis of randomised controlled trials

M Michael, E Hodson, J Craig, S Martin, V Moyer.

Centre for Kidney Research, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145

Introduction. Conventional treatment duration for UTI in children is 7-14 days. However shorter courses of treatment (2-4 days) may be as effective and improve compliance. This review aims to compare the efficacy of short courses of antibiotics with the standard duration in UTI in children.
Methods. Randomised controlled trials comparing short course antibiotic therapy (2-4 days) with standard therapy (7-14 days) for childhood UTI were identified from the Cochrane Controlled Trials Register, Medline, Embase, reference lists of articles, abstracts from proceedings and contact with known investigators in the area. Trials comparing single dose or 1 day treatment with standard were excluded. Two reviewers independently reviewed all eligible studies for inclusion, assessed study quality (concealment allocation, intention to treat, completeness of follow-up and blinding of outcome assessment) and extracted data. A random effects model was used to estimate summary relative risk (RR) with 95% confidence intervals (CI) after testing for heterogeneity.
Results. Twelve eligible trials with outcome data from 652 children were identified. Children considered to have pyelonephritis or with known urinary tract abnormalities were excluded in all trials. The number of children with bacteriuria did not differ significantly between short and standard durations at the end of treatment (8 comparisons; RR 1.06 (95% CI 0.64-1.76) or at 10 days to 15 months after treatment (11 comparisons; RR etc). No significant adverse effects were reported; 5 children had gastrointestinal symptoms, 2 a rash and 1 had dizziness.
Conclusions. Children with UTI without pyelonephritis can be treated equally effectively with a short course (2-4 days) or with a standard course (7-14 days) of antibiotics.

Presented at the Royal Australasian College of Physicians Annual Scientific Meeting, Sydney, May 2001.

Correspondence
Dr Elisabeth Hodson
ElisaH@chw.edu.au