Skip to main content
NCBI home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 2002 Aug;87(2):118–123. doi: 10.1136/adc.87.2.118

Short compared with standard duration of antibiotic treatment for urinary tract infection: a systematic review of randomised controlled trials

M Michael 1, E Hodson 1, J Craig 1, S Martin 1, V Moyer 1
PMCID: PMC1719177  PMID: 12138060

Abstract

Aims: To compare the effectiveness of short course (2–4 days) with standard duration oral antibiotic treatment (7–14 days) for urinary tract infection (UTI).

Methods: Meta-analysis of randomised controlled trials using a random effects model. Ten trials were eligible, involving 652 children with lower tract UTI recruited from outpatient or emergency departments. Main outcome measures were UTI at the end of treatment, UTI during follow up (recurrent UTI), and urinary pathogens resistant to the treating antibiotic.

Results: There was no significant difference in the frequency of positive urine cultures between the short (2–4 days) and standard duration therapy (7–14 days) for UTI in children at 0–7 days after treatment (eight studies: RR 1.06; 95% CI 0.64 to 1.76) and at 10 days to 15 months after treatment (10 studies: RR 1.01; 95% CI 0.77 to 1.33). There was no significant difference between short and standard duration therapy in the development of resistant organisms in UTI at the end of treatment (one study: RR 0.57, 95% CI 0.32 to 1.01) or in recurrent UTI (three studies: RR 0.39, 95% CI 0.12 to 1.29).

Conclusion: A 2–4 day course of oral antibiotics is as effective as 7–14 days in eradicating lower tract UTI in children.

Full Text

The Full Text of this article is available as a PDF (341.3 KB).

Figure 1 .

Figure 1

Open in a new tab

Meta-analyses showing the summary and individual trial relative risks (95% CI) for (A) persistence of urinary tract infection at the end of treatment (8 data sets) and (B) recurrence of infection 10 days to 15 months (12 data sets) after treatment with short duration or standard duration of antibiotics. Trials are shown ordered by study weights. No heterogeneity was shown using Cochran's Q statistic (χ2). The test statistic Z indicates that there were no significant differences between short and standard durations of antibiotic therapy.

Figure 2 .

Figure 2

Open in a new tab

Meta-analyses showing the summary and individual trial relative risks (95% CI) for the number of urinary tract infections (UTI) caused by organisms resistant to the treating antibiotic (A) among persistent urinary tract infections at the end of treatment (1 data set) and (B) among recurrent UTI 10 days to 15 months (3 data sets) after treatment with short duration or standard duration of antibiotics. Trials are shown ordered by study weights.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Craig J. C., Irwig L. M., Knight J. F., Sureshkumar P., Roy L. P. Symptomatic urinary tract infection in preschool Australian children. J Paediatr Child Health. 1998 Apr;34(2):154–159. doi: 10.1046/j.1440-1754.1998.00190.x. [DOI] [PubMed] [Google Scholar]
  2. Dickersin K., Scherer R., Lefebvre C. Identifying relevant studies for systematic reviews. BMJ. 1994 Nov 12;309(6964):1286–1291. doi: 10.1136/bmj.309.6964.1286. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Egger M., Davey Smith G., Schneider M., Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997 Sep 13;315(7109):629–634. doi: 10.1136/bmj.315.7109.629. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Gaudreault P., Beland M., Girodias J. B., Thivierge R. L. Single daily doses of trimethoprim/sulphadiazine for three or 10 days in urinary tract infections. Acta Paediatr. 1992 Sep;81(9):695–697. doi: 10.1111/j.1651-2227.1992.tb12336.x. [DOI] [PubMed] [Google Scholar]
  5. Gupta K., Scholes D., Stamm W. E. Increasing prevalence of antimicrobial resistance among uropathogens causing acute uncomplicated cystitis in women. JAMA. 1999 Feb 24;281(8):736–738. doi: 10.1001/jama.281.8.736. [DOI] [PubMed] [Google Scholar]
  6. Hansson S., Jodal U., Norén L., Bjure J. Untreated bacteriuria in asymptomatic girls with renal scarring. Pediatrics. 1989 Dec;84(6):964–968. [PubMed] [Google Scholar]
  7. Helin I. Short-term treatment of lower urinary tract infections in children with trimethoprim/sulphadiazine. Infection. 1981;9(5):249–251. doi: 10.1007/BF01640727. [DOI] [PubMed] [Google Scholar]
  8. Helin I. Three-day therapy with cephalexin for lower urinary tract infections in children. Scand J Infect Dis. 1984;16(3):305–307. doi: 10.3109/00365548409070405. [DOI] [PubMed] [Google Scholar]
  9. Hellström A., Hanson E., Hansson S., Hjälmås K., Jodal U. Association between urinary symptoms at 7 years old and previous urinary tract infection. Arch Dis Child. 1991 Feb;66(2):232–234. doi: 10.1136/adc.66.2.232. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Johnson C. E., Maslow J. N., Fattlar D. C., Adams K. S., Arbeit R. D. The role of bacterial adhesins in the outcome of childhood urinary tract infections. Am J Dis Child. 1993 Oct;147(10):1090–1093. doi: 10.1001/archpedi.1993.02160340076018. [DOI] [PubMed] [Google Scholar]
  11. Jójárt G. Comparison of 3-day versus 14-day treatment of lower urinary tract infection in children. Int Urol Nephrol. 1991;23(2):129–134. doi: 10.1007/BF02549709. [DOI] [PubMed] [Google Scholar]
  12. Khan A. J., Kumar K., Evans H. E. Three-day antimicrobial therapy of urinary tract infection. J Pediatr. 1981 Dec;99(6):992–994. doi: 10.1016/s0022-3476(81)80040-6. [DOI] [PubMed] [Google Scholar]
  13. Kornberg A. E., Sherin K., Veiga P., Mydlow P. K., Collins J. J., Feld L. G. Two-day therapy with cefuroxime axetil is effective for urinary tract infections in children. Am J Nephrol. 1994;14(3):169–172. doi: 10.1159/000168709. [DOI] [PubMed] [Google Scholar]
  14. Lohr J. A., Hayden G. F., Kesler R. W., Gleason C. H., Wood J. B., Ford R. F., Perriello V. A., Benjamin J. T., Dickens M. D. Three-day therapy of lower urinary tract infections with nitrofurantoin macrocrystals: a randomized clinical trial. J Pediatr. 1981 Dec;99(6):980–983. doi: 10.1016/s0022-3476(81)80037-6. [DOI] [PubMed] [Google Scholar]
  15. Madrigal G., Odio C. M., Mohs E., Guevara J., McCracken G. H., Jr Single dose antibiotic therapy is not as effective as conventional regimens for management of acute urinary tract infections in children. Pediatr Infect Dis J. 1988 May;7(5):316–319. doi: 10.1097/00006454-198805000-00004. [DOI] [PubMed] [Google Scholar]
  16. McCracken G. H., Jr, Ginsburg C. M., Namasonthi V., Petruska M. Evaluation of short-term antibiotic therapy in children with uncomplicated urinary tract infections. Pediatrics. 1981 Jun;67(6):796–801. [PubMed] [Google Scholar]
  17. Moffatt M., Embree J., Grimm P., Law B. Short-course antibiotic therapy for urinary tract infections in children. A methodological review of the literature. Am J Dis Child. 1988 Jan;142(1):57–61. doi: 10.1001/archpedi.1988.02150010067024. [DOI] [PubMed] [Google Scholar]
  18. Moher D., Pham B., Jones A., Cook D. J., Jadad A. R., Moher M., Tugwell P., Klassen T. P. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet. 1998 Aug 22;352(9128):609–613. doi: 10.1016/S0140-6736(98)01085-X. [DOI] [PubMed] [Google Scholar]
  19. Philbrick J. T., Bracikowski J. P. Single-dose antibiotic treatment for uncomplicated urinary tract infections. Less for less? Arch Intern Med. 1985 Sep;145(9):1672–1678. [PubMed] [Google Scholar]
  20. Ronald A. R., Boutros P., Mourtada H. Bacteriuria localization and response to single-dose therapy in women. JAMA. 1976 Apr 26;235(17):1854–1856. [PubMed] [Google Scholar]
  21. Schulz K. F., Chalmers I., Hayes R. J., Altman D. G. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA. 1995 Feb 1;273(5):408–412. doi: 10.1001/jama.273.5.408. [DOI] [PubMed] [Google Scholar]
  22. Shapiro E. D. Short course antimicrobial treatment of urinary tract infections in children: a critical analysis. Pediatr Infect Dis. 1982 Sep-Oct;1(5):294–297. doi: 10.1097/00006454-198209000-00002. [DOI] [PubMed] [Google Scholar]
  23. Tambic T., Oberiter V., Delmis J., Tambic A. Diagnostic value of a P-fimbriation test in determining duration of therapy in children with urinary tract infections. Clin Ther. 1992 Sep-Oct;14(5):667–671. [PubMed] [Google Scholar]
  24. Tran D., Muchant D. G., Aronoff S. C. Short-course versus conventional length antimicrobial therapy for uncomplicated lower urinary tract infections in children: a meta-analysis of 1279 patients. J Pediatr. 2001 Jul;139(1):93–99. doi: 10.1067/mpd.2001.114698. [DOI] [PubMed] [Google Scholar]
  25. Wientzen R. L., McCracken G. H., Jr, Petruska M. L., Swinson S. G., Kaijser B., Hanson L. A. Localization and therapy of urinary tract infections of childhood. Pediatrics. 1979 Mar;63(3):467–474. [PubMed] [Google Scholar]
  26. Winberg J., Andersen H. J., Bergström T., Jacobsson B., Larson H., Lincoln K. Epidemiology of symptomatic urinary tract infection in childhood. Acta Paediatr Scand Suppl. 1974;(252):1–20. doi: 10.1111/j.1651-2227.1974.tb05718.x. [DOI] [PubMed] [Google Scholar]
  27. Zaki M., Helin I. Nalidixic acid and trimethoprim/sulphamethoxazole as alternatives for short-term treatment of urinary infections. Ann Trop Paediatr. 1986 Sep;6(3):205–207. doi: 10.1080/02724936.1986.11748440. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES