Three-Day Therapy of Lower Urinary Tract Infections with Nitrofurantoin Macrocrystals: A Randomized Clinical Trial

Lohr, Jacob A.; Hayden, Gregory F.; Kesler, Richard W.; Gleason, Charles H.; Wood, James B.; Ford, Roseanne M.; Perriello, Vito A.; Benjamin, John T.; Dickens, Michael D.

doi:10.1016/s0022-5347(17)54314-1

Cited by 4 publications

(5 citation statements)

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“…Recurrent infections beyond 2 weeks were considered reinfections. 14,21,29 • Reinfection denotes initial bacteriologic cure followed by recurrence of symptoms and infection with a different organism. For studies unable to type organisms, we assumed that any recurrence Ͼ2 weeks after cessation of treatment represented infection with a new organism.…”

Section: Data Extractionmentioning

confidence: 99%

A Meta-analysis of Randomized, Controlled Trials Comparing Short- and Long-Course Antibiotic Therapy for Urinary Tract Infections in Children

Chan

2002

Pediatrics

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ABSTRACT. Background. Short-course antibiotic regimens, ranging in duration from a single dose to 3 days, are the current standard of care for the treatment of acute lower urinary tract infections (UTIs) in adult women. Despite multiple small randomized, controlled trials (RCTs) showing no difference in efficacy between shortcourse (<3 days) and long-course (7-14 days) therapy in children, concerns about occult pyelonephritis and renal scarring have prompted standard recommendations of 7 to 14 days of antibiotics for UTIs in children.Objective. To determine whether long-course antibiotic therapy is more effective than short-course therapy for the treatment of UTIs in children, and to explore potential sources of heterogeneity in the results of existing studies.Methods. We searched online bibliographic databases (Medline and Cochrane Clinical Trials Registry) for RCTs comparing short-and long-course therapy for the treatment of UTI in children, and examined the references of all retrieved articles. Candidate studies for meta-analysis were restricted to RCTs comparing shortcourse (<3 days) and long-course (7-14 days) outpatient therapy for acute UTI in children age 0 to 18 years. We excluded studies that were restricted to children with recurrent UTI or included children with asymptomatic bacteriuria. Sixteen studies met the inclusion criteria. Study quality was evaluated using a 9-item scoring system developed by the investigators. Data on the primary outcomes-treatment failure and reinfection rate-were extracted when available and reanalyzed based on intention to treat whenever possible. To determine whether anatomic level of infection (upper vs lower urinary tract) influenced the results, the meta-analysis was repeated on the subgroup of studies that attempted to restrict their participants to children with lower UTI. To determine whether there was a dose-response effect for the duration of short-course therapy, we performed separate subgroup analyses of studies of single-dose or single-day therapy and studies of 3-day therapy. To explore other potential sources of study result heterogeneity, such as study quality and patient age, we developed a random-effects regression model that included these variables as covariates.Results. S hort-course antibiotic regimens, ranging in duration from a single dose to 3 days, are the current standard of care for the treatment of uncomplicated lower urinary tract infections (UTIs) in women. 1 In addition to being effective, shorter treatment regimens are less expensive, improve adherence, have fewer side effects, and may prevent reinfections with resistant organisms. 2,3 Despite the proven efficacy and advantages of short-course antibiotic treatment of lower UTI in adults, pediatricians have hesitated to extrapolate this practice to children for several reasons. By the time UTIs are identified in preverbal children, there is often upper tract involvement that cannot be reliably and easily distinguished from lower tract disease by clinical signs and symptoms or laboratory test...

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Section: Data Extractionmentioning

confidence: 99%

A Meta-analysis of Randomized, Controlled Trials Comparing Short- and Long-Course Antibiotic Therapy for Urinary Tract Infections in Children

Chan

2002

Pediatrics

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“…Thus ten trials were included in the systematic review. [17][18][19][20][21][22][23][24][25][26] Table 1 summarises trial characteristics. Two trials 20 23 had four arms and were treated as separate trials.…”

Section: Trial Characteristicsmentioning

confidence: 99%

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

Michael

Hodson²,

Craig³

et al. 2002

Archives of Disease in Childhood

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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).

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“…Wientzen et al (14) demonstrated that a four-day course of amoxacillin at standard dose was as successful in symptomatic patients as a more conventional ten-day course, based on the rate of recurrencies. Lohr et al (15) studied the comparative efficacy of three-day versus ten-day nitrafurantoin macrocrystals therapy. As measured by relapse rate (8% vs. 9%) and reinfection rate (23% vs. 30%), the patients on three-day therapy responded as well as those on ten-day therapy.…”

Section: Vol (Ml)mentioning

confidence: 99%

Single‐Dose Netilmicin Therapy of Complicated and Uncomplicated Lower Urinary Tract Infections in Children

et al. 1985

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Thirty children (age 3 months to 10 years) with complicated and uncomplicated lower urinary tract infections were treated with a single intramuscular injection of netilmicin 4.5 mg/kg. The diagnosis of lower urinary tract infection was based on the absence of fever and the presence of normal values for erythrocyte sedimentation rate, C-reactive protein concentration and urinary excretion of N-acetyl-beta-D-glucosaminidase. Follow-up urine cultures in all children demonstrated a cure rate of 97% and reinfection and relapse rates each of 7% respectively. The subgroup (12 children) with radiological abnormalities of urinary tract showed a cure rate of 92%, and reinfection and relapse rates of 9% respectively. The rates of cure, reinfection and relapse in the complicated and uncomplicated urinary tract infections were not statistically different (p greater than 0.05). A pharmacokinetic study (performed in 5 children) demonstrated that netilmicin urinary concentrations were over the MIC's of the infecting organisms up to 96 hours after the single-dose injection. Netilmicin was well tolerated and no side effects appeared during treatment. Single-dose netilmicin therapy is an effective and safe regimen for complicated and uncomplicated urinary tract infections in children. The response to single-dose netilmicin therapy seems to be related to its prolonged urinary elimination.

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Three-Day Therapy of Lower Urinary Tract Infections with Nitrofurantoin Macrocrystals: A Randomized Clinical Trial

Cited by 4 publications

References 0 publications

A Meta-analysis of Randomized, Controlled Trials Comparing Short- and Long-Course Antibiotic Therapy for Urinary Tract Infections in Children

A Meta-analysis of Randomized, Controlled Trials Comparing Short- and Long-Course Antibiotic Therapy for Urinary Tract Infections in Children

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

Single‐Dose Netilmicin Therapy of Complicated and Uncomplicated Lower Urinary Tract Infections in Children

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