Written by Kimiko Dunbar
Spoon Feed
In children presenting with UTI without fever, short-course antibiotics (2-5 days) were as effective as standard duration (6-14 days).
What’s bacteriuria got to do with it?
UTIs are one of the most common bacterial infections in kids. Prior studies have demonstrated a decrease in bacteriuria at the completion of treatment in children who receive standard (i.e. longer) antibiotic treatment courses, but new studies (like STOP RCT and SCOUT RCT) have been published since the last meta-analysis.
This meta-analysis examined whether short-course (2-5 days) antimicrobials are as effective as standard-course (6-14 days) for pediatric UTIs. Nine randomized controlled trials (n=1171) showed no significant difference in UTI rates at therapy completion (RD 2.2%, 95%CI 0.0–4.3), though bacteriuria was modestly higher with short courses (RD 8.7%, CI 5.3–12.2). Late outcomes of UTI and bacteriuria 25-60 days after completing treatment were not significantly different between the two treatments. Authors note that there may be a difference in the population of patients presenting with UTI with and without fever. The majority of studies in the meta-analysis included patients presenting without fever; thus, future research on treatment courses with fever plus UTI may be needed.
How does this change my practice?
While there was a small increased risk of bacteriuria in children receiving short courses of antibiotic therapy, the clinical significance of asymptomatic bacteriuria is unclear. Further, given no difference in late outcomes 25-70 days after completion, I’m inclined to believe a short course of antibiotics is just as good. In uncomplicated UTI, I’ll lean towards a short course of treatment, especially in the absence of fever.
Source
Short- versus standard-course antimicrobial therapy for children with urinary tract infection: A meta-analysis. Acta Paediatr. 2025 Mar;114(3):479-486. doi: 10.1111/apa.17546. Epub 2024 Dec 17. PMID: 39690862
