Treatment failures were slightly more common after five versus 10 days of antibiotics, but the approach still is worth considering.

Short courses of antibiotic therapy (i.e. three to seven days) for uncomplicated urinary tract infections (UTIs) in adults have long been recommended, but whether they are safe for children is less clear. In this multisite trial, researchers randomized 664 children (age range, 2 months to 10 years) with UTIs (diagnosed based on typical symptoms and laboratory tests) who were improving after five days of antibiotics to five additional days of antibiotics or placebo. Subjects received one of five common antibiotics (i.e. amoxicillin-clavulanate, cefixime, cefdinir, cephalexin or trimethoprim-sulfamethoxazole). Exclusion criteria included mixed or antibiotic-resistant flora, hospitalisation and urinary tract abnormalities.

Treatment failure between day six and days 11 to 14 occurred in 4.2% of children who received only five days of antibiotics and in 0.6% of children who received standard 10-day therapy; the difference was statistically significant. Children who received short-course therapy also were more likely to have asymptomatic bacteriuria at days 11 to 14 than were those who received 10 days of treatment (8.6% vs 3.4%). Serious adverse events were uncommon and similar between groups.

Comment: The difference in treatment failure between short-course and standard therapy was small, which suggests that a short course still could be considered for children who are improving after five days, even those who present with fever. Maintaining a 10-day regimen with longer exposure to at least minor side effects can be annoying to both children and parents, making adherence challenging. Editorialists note that assessing treatment failure at 11 to 14 days, just a few days after the 10-day group stopped antibiotics, could artificially favour standard treatment, since the follow-up interval is shorter than in the five-day group. Overall, a reasonable middle ground is to consider a five-day course, but perhaps only for older children (more than 2 years) without initial fever, and with close follow up.

Thomas L. Schwenk, MD, Professor Emeritus, Family and Community Medicine, University of Nevada School of Medicine, Reno, USA.

Zaoutis T, et al. Short-course therapy for urinary tract infections in children: the SCOUT randomized clinical trial. JAMA Pediatr 2023; 177: 782-789.

Milstone AM, Tamma PD. Does the SCOUT trial fall short of determining an effective treatment duration for pediatric urinary tract infections? JAMA Pediatr 2023; 177: 756-758.

This summary is taken from the following Journal Watch titles: Infectious Diseases, Pediatrics and Adolescent Medicine.