Original articles
Short-course versus conventional length antimicrobial therapy for uncomplicated lower urinary tract infections in children: A meta-analysis of 1279 patients

https://doi.org/10.1067/mpd.2001.114698Get rights and content

Abstract

Objective: The objective was to compare the efficacies of single-dose, short-course (4 days or less), and standard course (5 days or greater) antimicrobial therapy for uncomplicated childhood cystitis. Methods: Prospective, randomized, controlled trials comparing 4 days or less of therapy (short courses) with 5 days or more of therapy (conventional therapy) were included if all of the subjects were <18 years of age, the initial infection was documented by urine culture, at least 1 subsequent culture was obtained between 3 and 30 days of enrollment, and some attempt was made to separate upper tract from lower tract infection. Composite differences among treatment groups were compared with a fixed or random effects model, depending on the test for heterogeneity. Results: Of the 517 citations identified by literature search, 37 were selected for detailed review, and 22 were included in the final meta-analysis. The overall difference in cure rates between short and conventional courses of therapy was significant (6.38%; 95% CI: 1.88% to 10.89%), favoring the conventional course. Similar results were obtained when only studies comparing the same agents in the short and conventional courses were included (7.92%; 95% CI: 2.09% to 13.8%). Short-course amoxicillin was inferior to conventional length course (difference in cure rate, 13%; 95% CI: 4% to 24%); no difference was found between short-course and conventional length courses of trimethoprim-sulfamethoxazole (difference in cure rate, 6.24%; 95% CI = –3.74% to 16.2%). Conclusions: We conclude that single-dose amoxicillin is inadequate therapy for uncomplicated cystitis of childhood. Three days of trimethoprim-sulfamethoxazole therapy appears to be as effective as conventional length courses of the drug. (J Pediatr 2001;139:93-9)

Section snippets

Study Identification

An online search of the MEDLINE database covering the period of 1966 to 1999 was performed with the following Medical Subject Headings, key words, and text words: “Urinary tract infection” and “antibiotic course.” The following filters were applied: English language, human research, all children (0 to 18 years), and randomized controlled trials. The bibliography of each article was searched by hand for additional relevant studies.

Study Selection and Data Abstraction

Studies were selected by a protocol established in advance of the

Study Identification and Selection

The literature search yielded 517 citations: 505 from MEDLINE and 12 from the reference lists of retrieved articles. Studies were excluded if the designs were nonexperimental, evaluated adult patients, were in languages other than English, or compared 2 different antibiotics for the same length of treatment. Review articles were also excluded. After the titles and abstracts of each citation were examined, 37 studies were selected as potentially relevant. Of the 37 studies selected, 15 failed to

DISCUSSION

Short-course antimicrobial therapy for lower urinary tract infections is the standard of care for adults.1, 43, 44 The option of using such a regimen in children with uncomplicated lower urinary tract infections is appealing because it provides the shortest, cheapest, and safest treatment. A large number of randomized double-blinded studies comparing single-dose/short-course treatment with conventional treatment (5 days or more of antibiotics) have been completed in children. Most of these

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    Reprint requests: Stephen C. Aronoff, MD, Department of Pediatrics, Temple University Children’s Medical Center, 3509 N Broad St, Philadelphia, PA 19140.

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