Effectiveness of Short-Course Antibiotic Treatment in Uncomplicated, Non-Bacteremic Pediatric Urinary Tract Infections: A Rapid Systematic Review
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Purpose: Urinary tract infections (UTIs) pose a significant disease burden in children. This study aims to determine whether a short-course regimen is non-inferior to a standard-course regimen in children with UTIs without complication and presence of bacteremia, and to define, in the optimal way possible, the term “short-course” in this context. Methods: We conducted a rapid systematic review of research up to April 2021 in PubMed, Embase, and Cochrane databases. We included studies that compared clinical outcomes in pediatric UTIs treated with short-course(≤4 days) or standard (≥5–7 days) courses. Results: Our analysis suggests that short-course regimes have equivalent efficacy to standardcourse regimens, with similar clinical cure rates and recurrence rates. All 10 studies comparing the clinical cure rates of short- and standard-course regimens reported comparable outcomes. The study evaluating renal scarring indicated no inferiority of short-course regimens compared to standard-course ones. Regarding UTI relapse, 8 out of 10 studies reported no significant difference in outcomes between short- and standard-course regimens. Conclusions: Our results purpose that short-course UTI regimens of 6 days or less are just as effective as standard-term regimens of 7 days or more in terms of infection cure and prevention of recurrence. Considering the equivalent rates of clinical cure and relapse between short- and standard-course regimens, it could be inferred that short-course regimens might be a more optimal strategy for managing pediatric UTIs without increasing the risk of complications.
Abstract
Purpose: Urinary tract infections (UTIs) pose a significant disease burden in children. This study aims to determine whether a short-course regimen is non-inferior to a standard-course regimen in children with UTIs without complication and presence of bacteremia, and to define, in the optimal way possible, the term “short-course” in this context. Methods: We conducted a rapid systematic review of research up to April 2021 in PubMed, Embase, and Cochrane databases. We included studies that compared clinical outcomes in pediatric UTIs treated with short-course(≤4 days) or standard (≥5–7 days) courses. Results: Our analysis suggests that short-course regimes have equivalent efficacy to standardcourse regimens, with similar clinical cure rates and recurrence rates. All 10 studies comparing the clinical cure rates of short- and standard-course regimens reported comparable outcomes. The study evaluating renal scarring indicated no inferiority of short-course regimens compared to standard-course ones. Regarding UTI relapse, 8 out of 10 studies reported no significant difference in outcomes between short- and standard-course regimens. Conclusions: Our results purpose that short-course UTI regimens of 6 days or less are just as effective as standard-term regimens of 7 days or more in terms of infection cure and prevention of recurrence. Considering the equivalent rates of clinical cure and relapse between short- and standard-course regimens, it could be inferred that short-course regimens might be a more optimal strategy for managing pediatric UTIs without increasing the risk of complications.
참고문헌 (14)
- Okarska-Napierała M, "Urinary tract infection in children : diagnosis, treatment, imaging-comparison of current guidelines", J Pediatr Urol, 13, pp.567~573 (2017)
- Subcommittee on Urinary Tract Infection, "Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months", Pediatrics, 128, pp.595~610 (2011)
- Abrahamsson K, "Antibiotic treatment for five days is effective in children with acute cystitis", Acta Paediatr, 91, pp.55~58 (2002)
- Afolabi TM, "Association of antibiotic treatment duration with recurrence of uncomplicated urinary tract infection in pediatric patients", Ann Pharmacother, 54, pp.757~766 (2020)
- Bouissou F, "Prospective, randomized trial comparing short and long intravenous antibiotic treatment of acute pyelonephritis in children : dimercaptosuccinic acid scintigraphic evaluation at 9 months", Pediatrics, 121, pp.e553~e560 (2008)
- Brady PW, "Length of intravenous antibiotic therapy and treatment failure in infants with urinary tract infections", Pediatrics, 126, pp.196~203 (2010)
- Fox MT, "Comparative effectiveness of antibiotic treatment duration in children with pyelonephritis", JAMA Netw Open, 3, pp.e203951~ (2020)
- Lessard DA, "Transition to oral antibiotic therapy for pyelonephritis in children under 60 days of age : an observational retrospective cohort study", Paediatr Child Health, 26, pp.27~31 (2020)
- Lewis-de Los Angeles WW, "Trends in intravenous antibiotic duration for urinary tract infections in young infants", Pediatrics, 140, pp.e20171021~ (2017)
- Marsh MC, "Relationship between clinical factors and duration of IV antibiotic treatment in neonatal UTI", Hosp Pediatr, 10, pp.743~749 (2020)
- McMullen JA, "Predictors of long length of stay in infants hospitalized with urinary tract infection", Hosp Pediatr, 4, pp.291~297 (2014)
- Michael M, "Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children", Cochrane Database Syst Rev, pp.CD003966~ (2023)
- Zaoutis T, "Short-course therapy for urinary tract infections in children : the SCOUT randomized clinical trial", JAMA Pediatr, pp.e231979~ (2023)
- Kaufman J, "Urinary tract infections in children : an overview of diagnosis and management", BMJ Paediatr Open, 3, pp.e000487~ (2019)