Is Shorter Better in Pediatric UTI?

Reviewed by: Zach Willis, MD, MPH

The optimal duration of therapy for pediatric UTI is poorly defined; current American Academy of Pediatrics (AAP) guidelines for children 2-24 months of age with UTI recommend 7-14 days of antibiotics. In this double-blinded, placebo-controlled clinical trial, children 2 months to 10 years of age who had been diagnosed with UTI and were improving by Day 5 of antibiotics were randomized to receive 5 or 10 days of effective oral antibiotics. Ultimately, 0.6% of children in the 10-day group and 4.2% of children in the 5-day group had treatment failure (a UTI, which required presence of symptoms, abnormal urinalysis, and growth on urine culture) between Day 6 and the Day 11-14 visit; this result did not meet prespecified criteria to demonstrate that short-course therapy was noninferior to long-course therapy. However, the authors conclude that, despite the finding that treatment failure was more likely in the short-course recipients, the treatment failure rate was low enough in both groups that a 5-day course might be a reasonable option for children who had improved by that time point.

Zaoutis T, Shaikh N, Fisher BT, et al. Short-Course Therapy for Urinary Tract Infections in Children: The SCOUT Randomized Clinical Trial. JAMA Pediatrics 2023; 177:782–789.

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