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

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).

Antibiotic resistance of urinary tract pathogens and rationale for empirical intravenous therapy

“…Modern cephalosporins, such as cefuroxime, cefixime, or cefdinir, which were not analyzed in this study, appear to be the main drugs of choice for oral treatment. Nevertheless, short intravenous treatment might be still an appropriate alternative in some children, or mandatory in severely affected patients [23,24]. Since resistance patterns may vary in different regions, it is mandatory that hospitals formulate their antibiotic policy according to their local resistance pattern, which must be assessed in hospital and laboratory-based surveillance studies.…”

Induction of a State of Iron Limitation in Uropathogenic Escherichia coli CFT073 by Cranberry-Derived Proanthocyanidins as Revealed by Microarray Analysis

“…The principal treatment intervention in patients with acute UTIs is oral therapy with antibiotics. The standard treatment for managing recurrent, uncomplicated UTIs in women is continuous or postcoital prophylaxis with low-dose antimicrobials or intermittent selftreatment with antimicrobials (2,13,23). However, the development of bacterial resistance to antibiotics has resulted in rising rates of clinical failure (2,3,17), emphasizing the need to develop alternate options for infection prevention and treatment.…”

Antibiotic treatment for acute ‘uncomplicated’ or ‘primary’ pyelonephritis: a systematic, ‘semantic revision’

“…At present, the information retrieved from the RCT of the treatment of acute pyelonephritis fails to answer the question, 'Do we have enough evidence to choose a treatment aimed at avoiding kidney scars?' Furthermore, the literature dealing with children, which considers scars as a major end-point, may have failed to use therapy of sufficient duration to avoid scarring and were mainly designed as 'equivalence studies' [67][68][69].…”