Source/Disclosures
Disclosures:
Shaikh reports receiving grants from the National Institute of Allergy and Infectious Diseases during the conduct of the study. Please see the study for all other authors’ relevant financial disclosures. Milstone and Tamma report no relevant financial disclosures.
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Key takeaways:
- UTIs in children are usually treated for 10 days.
- New research suggests that a 5-day treatment could be sufficient for some patients.
A shorter course of antibiotics may be enough to treat some pediatric UTIs, a study found, although experts encouraged physicians to speak to parents about a potentially increased risk for treatment failure from a shorter course.
The randomized clinical noninferiority SCOUT trial found that children who received a standard 10-day course of antibiotics for UTI had lower rates of treatment failure than children who received a 5-day course but also that treatment failure was low in both arms of the trial.
“The study provides data that [support] using shorter treatment courses,” Nader Shaikh, MDmph, a professor of pediatrics and clinical and translational science at the University of Pittsburgh School of Medicine, told Healio.
According to Shaikh, pediatric patients are usually treated for UTIs for up to 10 days, compared with adult treatment that usually lasts for 3 to 7 days.
“There’s really not that many studies that have looked at duration of treatments for UTIs (in children). Very few studies have covered it. And it’s surprising because this is a very common infection,” Shaikh said.
From May 2012 through August 2019, Shaikh and colleagues enrolled children aged 2 months to 10 years at The Children’s Hospital of Philadelphia or UPMC Children’s Hospital of Pittsburgh who were diagnosed with a UTI and prescribed one of five frequently used antimicrobials.
The results included 664 children who were assigned to two groups: 328 who received a standard 10-day course of antibiotics, and 336 who received 5 days of antibiotic therapy plus 5 days of placebo.
By the first follow-up visit 11 to 14 days later, 0.6% of children in the standard course arm experienced treatment failure compared with 4.2% in the short course arm.
“[The results] were surprising because almost nobody failed in either group,” Shaikh said. “Less than 5% of people failed in both arms, so to me that says either one works pretty well — better than we thought.”
A 10-day course was also associated with lower rates of asymptomatic bacteriuria and positive urine culture at the first follow-up visit compared with a 5-day course, but there were no differences in rates of UTI, adverse events or antimicrobial resistance between the two groups after that visit, the researchers reported.
In the study, Shaikh and colleagues said the findings suggest that a short course “could be considered as a reasonable option for children exhibiting clinical improvement after
5 days of antimicrobial treatment.”
In an associated editorial, Aaron M Milstone, MD, MHS, other Pranita D. Tamma, MD, MHS, from the division of pediatric infectious diseases at the John Hopkins University School of Medicine, said the results can help guide shared clinical decision-making between health care providers and parents regarding length of treatment for pediatric UTIs.
“These conversations should acknowledge signs of clinical failure that would warrant a return to medical care and monitoring of antibiotic-associated adverse events,” they wrote.
“We commend the investigators for successfully completing a clinical trial that on the surface seems straightforward but, undoubtedly, took tremendous commitment to execute. Future research is needed to address an effective duration of therapy for children with complicated UTIs and those with UTIs warranting hospitalization.”
References:
Milstone AM, et al. JAMA Pediatr. 2023;doi:10.1001/jamapediatrics.2023.1976.
Zaoutis T, et al. JAMA Pediatr. 2023;doi:10. 1001/jamapediatrics.2023.1979.
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