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Treatment Failure Down With Standard-Course Therapy in Pediatric UTI

Children receiving short-course therapy also had increased likelihood of asymptomatic bacteriuria or positive urine culture at follow-up

By Elana Gotkine HealthDay Reporter

MONDAY, July 3, 2023 (HealthDay News) — For children with urinary tract infection (UTI), standard-course therapy is associated with lower rates of treatment failure, according to a study published online June 26 in JAMA Pediatrics.

Theoklis Zaoutis, M.D., from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, and colleagues compared the efficacy of standard-course and short-course therapy for children with UTI in a randomized clinical noninferiority trial. Data were included for 664 children aged 2 months to 10 years with UTI exhibiting clinical improvement after five days of antimicrobials who were randomly assigned to another five days of antimicrobials (standard-course therapy) or five days of placebo (short-course therapy; 328 and 336 children, respectively).

The researchers found that 0.6 and 4.2 percent of those assigned to standard-course and short-course therapy had treatment failure, defined as symptomatic UTI at or before the first follow-up visit (days 11 to 14; absolute difference, 3.6 percent; upper bound of 95 percent confidence interval, 5.5 percent). The likelihood of having asymptomatic bacteriuria or a positive urine culture at or by the first follow-up visit was increased for children receiving short-course therapy. No between-group differences were seen in the rates of UTI after the first follow-up visit, incidence of adverse events, or incidence of gastrointestinal colonization with resistant organisms.

“The slightly increased risk of treatment failure with the added benefit of convenience and potentially less adverse events should be discussed with parents; in this way, they can contribute to conversations surrounding the ultimate duration of therapy prescribed,” write the authors of an accompanying editorial.

Several authors disclosed ties to the pharmaceutical industry.

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