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Three Part Question

In a [child with diagnosed UTI] is a [short 2-4 day course of antibiotics better than a long 7-14 day course] in the [eradication of symptoms of UTI and prevention of recurrance]?

Clinical Scenario

A child is diagnosed with UTI and you want to prescibe some medication. You wonder whether a short 2-3 day course is better than longer 7-14 day course of antibiotics.

Search Strategy

Medline database 1966 to Nov 2006 via OVID.
The Cochrane Library 2006, Issue 4
Medline database 1966 to Nov 2006 via OVID.
[BestBETS paediatric filter] AND [urinary tract infection.mp./or exp Urinary Tract Infections] AND [duration.mp./or course.mp.] AND [antibiotics.mp./or exp Anti-Bacterial Agents/ or treatment.mp./or exp Therapeutics/or treatment$.mp.] Limit to human and English language
The Cochrane Library 2006, Issue 4: children AND uti

Search Outcome

325 papers were found on Medline, of these one was a recent systematic review which included all those papers identified as answering the 3 part question, found also in Cochrane

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Michael M, Hodson EM, Craig JC, Martin S, Moyer VA 2003, Issue 1 UK	Children older than 3 months and younger than 18 years with culture proven UTI	Systematic review and meta-analysis	Difference in frequency of positive urine cultures between the short (2-4 days) and standard duration oral antibiotic therapy (7-14 days) for UTI in children at 0-10 days after treatment	8 studies: RR 1.06; 95% CI 0.64 to 1.76	The authors themselves mention limitations associated with the primary studies included in the review. These include: lack of relevant information with regards to critical care, no information about how long it took for symptoms to subside after starting the antibiotics, and if recurrance of UTI was associated with any clinical features.
			Difference in frequency of positive urine cultures between the short (2-4 days) and standard duration oral antibiotic therapy (7-14 days) for UTI in children at 15 months after treatment	10 studies: RR 0.95; 95% CI 0.70 to 1.29
			Difference between short and standard duration therapy in the development of resistant organisms in UTI at the end of treatment	1 study: RR 0.57, 95% CI 0.32 to 1.01
			Difference between short and standard duration therapy in the development of resistant organisms in recurrent UTI	3 studies: RR 0.39; 95 CI 0.12 to 1.29

Comment(s)

This review addresses the three-part question directly and concludes that a short course of treatment is an effective choice in the treatment of childhood UTI.

Clinical Bottom Line

A short 2-4 day course of antibiotics is a reasonable treatment option for UTI in children.

References

1. Michael M, Hodson EM, Craig JC, Martin S, Moyer VA Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children (Review) The Cochrane Database of Systematic Reviews 20 January 2003, Issue 1. Art. No.:CD003966.DOI: 10.1002/14651858.CD003966