Shorter Antibiotic Course May Benefit Some Kids With UTIs

TOPLINE:

In children with febrile urinary tract infections (UTIs), individualised antibiotic treatment stopping at 3 days after the achievement of adequate clinical improvement compared with the standard 1src-day treatment regimen increased the risk for recurrent infections but reduced antibiotic use and the number of days of adverse events.

METHODOLOGY:

Researchers conducted a pragmatic trial (INDI-UTI) to evaluate whether individualised antibiotic treatment was non-inferior to standard 1src-day treatment in terms of recurrent UTIs and superior in reducing overall exposure to antibiotics.
A total of 4src8 patients (median age, 1.5 years; 8src% girls) with UTIs who were febrile (≥ 38 °C) and had significant growth of uropathogenic bacteria were included and were randomly assigned to either the individualised treatment group (n=2src5) or the standard 1src-day treatment group (n=2src3).
The individualised group received antibiotics for a minimum of 4 days, stopping treatment at 3 days after achievement of adequate clinical improvement, whereas the standard group received antibiotics for a full 1src days.
Primary outcomes were recurrent UTIs within 28 days after treatment cessation and the total number of antibiotic days within 28 days of treatment initiation; secondary outcomes were recurrent UTIs within 1srcsrc days after treatment cessation and the number of days absent from school or daycare due to any illness within 28 days after randomisation.
Treatment options included oral amoxicillin-clavulanic acid (5src mg amoxicillin + 12.5 mg clavulanic acid per kilogram per day in three doses), oral mecillinam (2src-4src mg per kilogram per day in three doses), or intravenous ampicillin (1srcsrc mg per kilogram per day in three doses) and gentamicin (5 mg per kilogram once daily).

TAKEAWAY:

The median antibiotic duration was 5.3 days (interquartile range [IQR], 4.8-6.5) in the individualised group and 1src.src days (IQR, 1src.src-1src.src) in the standard group.
Recurrent UTIs within 28 days occurred in a higher proportion of patients in the individualised group than in those in the standard group (11% vs 6%; difference, 5.3 percentage points; P_{non-inferiority} =.24), failing to establish the non-inferiority of the individualised antibiotic regimen.
However, the risk for recurrence with individualised vs standard antibiotic regimen appeared to equalise within 1srcsrc days of treatment cessation, with a difference of 1.8 percentage points (P_{non-inferiority}=.src12).
The incidence rate of antibiotic-related adverse events within 28 days was lower in the individualised group than in the standard group (rate ratio, src.61; P=.srcsrcsrc3).

IN PRACTICE:

“Given that most children responded well to shorter treatment, and even those requiring retreatment for non-febrile recurrences often had a total antibiotic duration shorter than that of children receiving standard 1src-day treatment, the benefits of reduced antibiotic exposure could outweigh the increased risk of recurrence. Further research is needed to identify children at higher risk of recurrence to avoid compromising their outcomes,” the authors wrote.

“The INDI-UTI trial is a crucial step in the right direction. Now that shorter therapy is standard for many infections, the next challenge is learning how to tailor treatment duration to the individual patient,” experts wrote in an accompanying editorial.

SOURCE:

This study was led by Naqash Javaid Sethi, MD, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. It was published online on April src2, 2src25, in The Lancet Infectious Diseases.

LIMITATIONS:

This trial did not mask treatment allocation, which may have led to non-adherence among patients receiving the standard 1src-day treatment as they might have believed in the non-inferiority of the individualised approach. This study followed Danish guidelines, which may not have aligned with other standards, potentially affecting the accuracy of UTI diagnosis. Additionally, numerous missing values for school or daycare absences and antibiotic-related adverse events existed, which could have introduced imprecision and bias. This study did not assess the effect of antibiotic treatment duration on the intestinal or urinary microbiome.

DISCLOSURES:

This study was supported by the Copenhagen University Hospital Rigshospitalet Research Fund, Innovation Fund Denmark, and Greater Copenhagen Health Science Partners. The authors declared having no competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.