Association of Antibiotic Treatment Duration With Recurrence of Uncomplicated Urinary Tract Infection in Pediatric Patients

Afolabi, Titilola M.; Goodlet, Kellie J.; Fairman, Kathleen A.

doi:10.1177/1060028019900650

Cited by 9 publications

(4 citation statements)

References 27 publications

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Section: Comparative Effectiveness Studies Of Complicated Urinary Tra...mentioning

confidence: 99%

“…Several observational studies have also been undertaken in recent years to better define effective durations of therapy for children with UTIs [83,84,85 ]. Afolabi et al [83] evaluated the association between duration of antibiotic therapy and risk or recurrent UTI in 7698 children aged 2-17 years treated in the outpatient setting, finding no difference in outcomes between durations of 7 days and 10-14 days. As an administrative database was used, there was likely residual confounding, missing data, and limitations in the ability to distinguish cystitis vs. pyelonephritis and uncomplicated vs. complicated UTIs, obscuring interpretation of the findings.…”

Section: Comparative Effectiveness Studies Of Complicated Urinary Tra...mentioning

confidence: 99%

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Defining effective durations of antibiotic therapy for community-acquired pneumonia and urinary tract infections in hospitalized children

Wingler

2022

Current Opinion in Infectious Diseases

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Purpose of reviewCommunity-acquired pneumonia (CAP) and urinary tract infections (UTI) are two common childhood infections often leading to hospital admission. National guidelines for CAP and UTI in children recommend durations of antibiotic therapy of 10 days and 7–14 days, respectively. Due to concerns of rising antimicrobial resistance and an increased awareness of harms associated with prolonged courses of antibiotics, there is a renewed emphasis on reevaluating commonly prescribed durations of antibiotic therapy across bacterial infections. We describe recent clinical trials and observational studies evaluating durations of therapy for CAP and UTI in adults and children and translate the findings to our suggested approach for selecting durations of antibiotic therapy in hospitalized children.Recent findingsThere is a growing body of evidence, primarily in adults, that shorter durations of therapy than are commonly prescribed are just as effective as longer durations for CAP and UTIs.SummaryCombining clinical trial data from adults with available data in children, we believe it is reasonable to consider 5 days of therapy for CAP, 3–5 days of therapy for cystitis, and 7 days of therapy for pyelonephritis for most hospitalized children with uncomplicated infections.

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Section: Comparative Effectiveness Studies Of Complicated Urinary Tra...mentioning

confidence: 99%

Section: Comparative Effectiveness Studies Of Complicated Urinary Tra...mentioning

confidence: 99%

Defining effective durations of antibiotic therapy for community-acquired pneumonia and urinary tract infections in hospitalized children

Wingler

2022

Current Opinion in Infectious Diseases

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“…This study adds to a small body of literature on adherence to improved antibiotic stewardship for treating uUTI in children. [16][17][18] Our study is the first to focus on implementing a 3-day treatment course for uUTI in a pediatric ED.…”

Section: Discussionmentioning

confidence: 99%

Improving Adherence to Evidence-based Practice for Uncomplicated UTI in a Pediatric Emergency Department

Kline

Powell

Albert

et al. 2023

Pediatric Quality &Amp; Safety

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Uncomplicated urinary tract infections (uUTIs) are among the more common bacterial infections in children. Despite their prevalence, significant variability exists in the treatment duration and antibiotic selection for uUTI. 1 Emerging evidence in the pediatric literature suggests a shorter duration of antibiotics for uUTIs is both efficacious and safe. [2][3][4][5][6] Clinical guidelines from the United Kingdom, Australia and New Zealand recommend 3 days of antibiotic therapy for children 3 months and older with uUTI. 3,4 A large, multicenter, randomized, double-blind, placebo-controlled trial of children aged 2 to ten years evaluating 5 days compared with ten days of treatment showed treatment success in 96% of children who received 5 days of treatment and no significant differences in recurrent infection or adverse events between groups. 5 Three days of treatment duration is strongly supported in the literature on adult female patients with multiple prospective randomized controlled trials showing equal efficacy with longer treatment duration. [7][8][9] The Infectious Diseases Society of America recommends 3 days of antibiotic therapy for uUTI in adult women. 10 Shorter treatment for uUTIs may reduce healthcare costs, antimicrobial resistance, the risk of drug-related toxicity and/or adverse effects, and increase patient adherence to prescribed regimens. 11 Treatment of pediatric uUTIs with first-generation cephalosporins is efficacious with low rates of antimicrobial resistance. 12,13

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“… 31 For this reason, we opted to add the requirement of evidence of an accompanying claim for an antibiotic prescription fill with a course duration of 14 days or less within 7 days of the initial diagnosis or an inpatient antibiotic code (eTable 1 in Supplement 1 ) for UTI-related antibiotics (eTable 2 in Supplement 1 ). 31 , 32 , 33 , 34 Any diagnosis of UTI occurring within 2 weeks of a previous diagnosis counted as a singular diagnosis due to potential return visits for the same infection. 32 A 2-week time period was selected since the longest recommended duration for antibiotic treatment is 14 days.…”

Section: Methodsmentioning

confidence: 99%

Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic

Liang,

Wang,

Dahlen

et al. 2024

JAMA Netw Open

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IMPORTANCEUrinary tract infection (UTI) is common in children, but the population incidence is largely unknown. Controversy surrounds the optimal diagnostic criteria and how to balance the risks of undertreatment and overtreatment. Changes in health care use during the COVID-19 pandemic created a natural experiment to examine health care use and UTI diagnosis and outcomes.OBJECTIVESTo examine the population incidence of UTI in children and assess the changes of the COVID-19 pandemic regarding UTI diagnoses and measures of UTI severity.DESIGN, SETTING, AND PARTICIPANTSThis retrospective observational cohort study used US commercial claims data from privately insured patients aged 0 to 17 years from January 1, 2016, to December 31, 2021.EXPOSURETime periods included prepandemic (January 1, 2016, to February 29, 2020), early pandemic (April 1 to June 30, 2020), and midpandemic (July 1, 2020, to December 31, 2021).MAIN OUTCOMES AND MEASURESThe primary outcome was the incidence of UTI, defined as having a UTI diagnosis code with an accompanying antibiotic prescription. Balancing measures included measures of UTI severity, including hospitalizations and intensive care unit admissions. Trends were evaluated using an interrupted time-series analysis.RESULTSThe cohort included 13 221 117 enrollees aged 0 to 17 years, with males representing 6 744 250 (51.0%) of the population. The mean incidence of UTI diagnoses was 1.300 (95% CI, 1.296-1.304) UTIs per 100 patient-years. The UTI incidence was 0.86 per 100 patient-years at age 0 to 1 year, 1.58 per 100 patient-years at 2 to 5 years, 1.24 per 100 patient-years at 6 to 11 years, and 1.37 per 100 patient-years at 12 to 17 years, and was higher in females vs males (2.48 [95% CI, 2.46-2.50] vs 0.180 [95% CI, 0.178-0.182] per 100 patient-years). Compared with prepandemic trends, UTIs decreased in the early pandemic: −33.1% (95% CI, −39.4% to −26.1%) for all children and −52.1% (95% CI, −62.1% to −39.5%) in a subgroup of infants aged 60 days or younger. However, all measures of UTI severity decreased or were not significantly different. The UTI incidence returned to near prepandemic rates (−4.3%; 95% CI, −32.0% to 34.6% for all children) after the first 3 months of the pandemic.CONCLUSIONS AND RELEVANCEIn this cohort study, UTI diagnosis decreased during the early pandemic period without an increase in measures of disease severity, suggesting that reduced overdiagnosis and/or reduced misdiagnosis may be an explanatory factor.

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Association of Antibiotic Treatment Duration With Recurrence of Uncomplicated Urinary Tract Infection in Pediatric Patients

Cited by 9 publications

References 27 publications

Defining effective durations of antibiotic therapy for community-acquired pneumonia and urinary tract infections in hospitalized children

Defining effective durations of antibiotic therapy for community-acquired pneumonia and urinary tract infections in hospitalized children

Improving Adherence to Evidence-based Practice for Uncomplicated UTI in a Pediatric Emergency Department

Incidence of Pediatric Urinary Tract Infections Before and During the COVID-19 Pandemic

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