• Ron Keren and Eugenia Chan.
• Department of Medicine, Children's Hospital, Boston, Massachusetts, USA. keren@email.chop.edu
• Pediatrics. 2002 May 1;109(5):E70-0.

BackgroundShort-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 short-course (ObjectiveTo 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.MethodsWe 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 short-course (ResultsThe pooled estimate for the relative risk (RR) of treatment failure with short-course antibiotic therapy was 1.94 (95% confidence interval [CI]: 1.19-3.15) and for the RR of reinfection was 0.76 (95% CI: 0.39-1.47). When we excluded the 3 studies that did not attempt to restrict their participants to patients with lower UTI, the pooled RR of treatment failure was 1.74 (95% CI: 1.05-2.88) and of reinfection was 0.69 (95% CI: 0.32-1.52). For the subgroup of studies comparing single-dose or 1-day therapy to long-course therapy, the pooled RR of treatment failure was 2.73 (95% CI: 1.38-5.40) and of reinfection was 0.37 (95% CI: 0.12-1.18). For the subgroup of studies comparing 3-day therapy to long-course therapy, the pooled RR of treatment failure was 1.36 (95% CI: 0.68-2.72) and of reinfection was 0.99 (95% CI: 0.46-2.13). In the meta-regression, neither study quality nor mean participant age was significantly associated with the odds ratio of treatment failure or reinfection, in either the complete set of studies or the subset of studies restricted to patients with lower UTI.ConclusionsIn pooled analyses of published studies comparing long- and short-course antibiotic treatment of UTI in children, long-course therapy was associated with fewer treatment failures without a concomitant increase in reinfections, even when studies including patients with evidence of pyelonephritis were excluded from the analysis. Until there are more accurate methods for distinguishing upper from lower UTI in children, no additional comparative trials are warranted and clinicians should continue to treat children with UTI for 7 to 14 days.

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