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Children with uncomplicated UTIs treated with 10 days vs 5 days of antibiotics have fewer treatment failures (SCOUT)
Clinical Question
Can children with uncomplicated urinary tract infections be successfully treated with short courses of antibiotics?
Bottom line
In this study, standard-course therapy for children with UTI was superior to short-course therapy. However, the number needed to treat of 28 suggests that offering short-course therapy is not unreasonable, especially if there is good follow-up in the subsequent weeks. 1b
Reference
Study design: Randomized controlled trial (double-blinded)
Funding: Government
Setting: Outpatient (any)
Synopsis
These researchers recruited children (aged 2 months to 10 years) within 2 to 5 days of being given a diagnosis of an uncomplicated urinary tract infection (UTI) who were being treated with amoxicillin-clavulanate, cefixime, cefdinir, cephalexin, or trimethoprim-sulfamethoxazole. On the fifth day, the researchers randomized the children who were improving (asymptomatic and afebrile) to receive 5 more days of the antibiotic (standard-course therapy, n = 348) or to 5 days of a matching placebo (short-course therapy, n = 336). For reference, the American Academy of Pediatrics guideline does not recommend tests of cure in this age group. Researchers masked to treatment assignment did in-person evaluations of the children 11 days to 14 days and 24 days to 30 days after the initial treatment. In addition to the clinical assessments, the researchers also collected urine samples for culture. The main outcome, treatment failure, was defined by all of the following: any symptoms or signs of UTI; pyuria (10 or more white blood cells/cubic milliliter or 5 or more white cells/high-powered field, each on centrifuged samples or trace or greater leukocyte esterase on a dipstick); a positive urine culture. Using a modified intention-to-treat analysis, the authors report that treatment failure occurred in 0.6% of children treated with standard courses and 4.2% of those treated with short courses. This investigation was set up as a noninferiority trial and the data do not support the noninferiority of short-course therapy. However, one would need to treat 28 children with standard-course therapy to prevent 1 treatment failure (95% CI 16 - 80). There was no statistically significant difference in the proportion of children with UTI symptoms on days 6 through 14 (9.1% vs 12.2%). Additionally, the outcomes did not differ by specific antibiotics. The rate of adverse events was similar in each group (47.3% and 43.8%, respectively).
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
Impact assessment
Excellent
UNCOMPLICATED UTI IN CHILDRENS
GOOD TO KNOW
outcome
N.B.: very high percentage reported for adverse effects !!
No
No
Short course antibiotic for pediatric UTI
Interesting abstract. I would not have predicted that the absolute difference in treatment failure in the short course group (4.2% failure) would be so "high" compared to the long course group (0.6%). If the goal of treatment is successful eradication of infection then I would think the practice of relying on "good follow up" for short course patients would meet with limited success. This suggestion is worth a follow up study to assess its value.