Short-Course vs Standard-Course Treatment for UTIs In Pediatric Patients
While short-courses of antimicrobial therapy are widely recognized as the standard care for adult patients with urinary tract infection (UTI), limited research has been done on efficacy of short-course therapy for UTI in pediatric populations.
Researchers conducted a randomized, double-blind, placebo-controlled trial to evaluate if short-course therapy was noninferior to standard therapy in 664 children with UTI exhibiting clinical improvement after 5 days of treatment.1 Short-course therapy was defined as 5 days of antimicrobial treatment, whereas standard therapy was 10 days of antimicrobial treatment, which is in line with the current recommendations by the American Academy of Pediatrics.
While the results demonstrated that the standard therapy group had lower rates of treatment failure than the short-course group, the short-course group had low failure rates, making short-course therapy a potential option for children with UTI who show improvement after 5 days of treatment.
"We commend the investigators for successfully completing a clinical trial that on the surface seems straightforward, but undoubtedly took tremendous commitment to execute," said Aaron M. Milstone, MD, MS, and Pranita D. Tamma, MS, MHS, in an accompanying editorial.2 "Future research is needed to address an effective duration of therapy for children with complicated UTIs and those with UTIs warranting hospitalization."
To learn a bit more about the study results, Consultant360 contacted the lead study author, Nader Shaikh, MD, MPH, from the Department of Pediatrics at University of Pittsburgh School of Medicine and UPMC Children’s Hospital of Pittsburgh, in Pittsburgh, PA.
C360: What prompted this study?
Nader Shaikh: No prior large, methodologically sound studies had looked at the optimal duration of treatment for UTI in children. We conducted this trial to better understand the pros and cons of standard vs short duration of treatment with antibiotics for children with UTI.
We also included about 250 children with fever so we could see if short duration of treatment might be appropriate for this subgroup. However, more studies are needed in children with febrile UTIs.
C360: Were you anticipating a similar response to short-course therapy in pediatric patients as that of adult populations? Was the outcome different than expected?
NS: We were expecting higher rates of treatment failure than the ones we observed. The low rates of treatment failure provide additional reassurance that short-course therapy is appropriate for the treatment of UTI in children, especially if they are afebrile.
C360: Could you discuss some of the benefits and drawbacks associated with the use of short-course therapy for the treatment of UTI in children?
NS: With shorter courses of therapy there is a smaller chance of developing antimicrobial resistance. UTI is a common condition in childhood, and this study provides an evidence-based approach to reducing antimicrobial use in children. Additionally, there is less chance of adverse effects and short-course therapy is much easier for the parents. About 4% of children who received the short-course treatment had a UTI at the time of follow-up, compared with 1% of children in the standard-course treatment group.
References:
- Zaoutis T, Shaikh N, Fisher BT, et al. Short-course therapy for urinary tract infections in children. JAMA Pediatrics. 2023;177(8):782-789. doi:10.1001/jamapediatrics.2023.1979
- Milstone AM, Tamma PD. Does the SCOUT trial fall short of determining an effective treatment duration for pediatriic urinary tract infections? JAMA Pediatrics. 2023;177(8):756-758. doi:10.1001/jamapediatrics.2023.1976.