Short- versus standard-course antimicrobial therapy for children with urinary tract infection: A meta-analysis

Aim: To determine if short- (2-5 days) course antimicrobials are as effective as standard- (6-14 days) course antimicrobials in the treatment of symptomatic UTI in children.

Methods: MEDLINE and EMBASE were searched from their origin to January 2024. We only considered randomised controlled trials in children <18 years of age. The main outcomes of interest were UTI or bacteriuria at the end of therapy.

Results: Nine studies were included. Compared to children treated with a standard course of antimicrobials, those treated with shortened courses of antimicrobials did not have significantly different risks of UTI at the end of therapy (risk difference 2.2%, CI: 0.0-4.3). Risk of bacteriuria at end of therapy (RD = 8.7%, CI: 5.3-12.2) was slightly higher in children treated with shorter courses. In children with fever at baseline (two studies), there was no significant difference in risk between short and standard duration treatment (RD = 0.4%, CI: -2.8 to 3.6).

Conclusion: In children without fever at the time of presentation, treatment with shorter courses of antimicrobials appears reasonable. More studies of febrile children are needed before shorter courses could be recommended for febrile children.