Short versus standard duration antibiotic therapy for urinary tract infection in children. A systematic review.

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

Centre for Kidney Research, The Children's Hospital at Westmead, NSW Australia

Introduction. Conventional oral antibiotic treatment for children with urinary tract infection (UTI) is 7-14 days, but shorter courses (2-4 days) of treatment may be as effective and improve compliance. This review aims to compare the effectiveness of short duration versus standard duration antibiotic therapy for children with UTI.

Method. 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 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 and extracted data. A random effects model was used to estimate the summary relative risk (RR) with 95% confidence intervals after testing for heterogeneity.

Results. Ten eligible trials (twelve data sets) with outcome data from 652 children aged between 3 months and 18 years were identified. Children with clinical evidence of pyelonephritis or with known urinary tract abnormalities were excluded in all trials. There was no significant difference between short and standard duration therapy with respect to persistence of bacteriuria at the end of treatment (8 comparisons; RR 1.06 (95% CI 0.64,1.76) or recurrence of UTI at 10 days to 15 months after treatment (11 comparisons; RR 0.94; 95% CI 0.68, 1.29). No significant adverse effects from treatment were reported in either group.

Conclusion. Children with UTI without pyelonephritis can be treated equally effectively with either short or standard courses of antibiotics.

Presented at the 12th Congress of the International Paediatric Nephrology Association, Seattle, September 2001

Correspondence:
Dr Elisabeth Hodson
ElisaH@chw.edu.au