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

Abstract

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