CLINICAL QUESTION

For febrile children with a urinary tract infection (UTI), is 5 days of treatment as effective as 10 days of treatment for resolving symptoms and preventing recurrence?

BOTTOM LINE

In children 3 months to 5 years of age who are febrile and have an uncomplicated UTI, 5 days of antibiotic treatment results in similar resolution of symptoms and 30-day recurrence rates as 10 days of treatment. (Level of Evidence = 1b)

SYNOPSIS

The study enrolled 142 children, 3 months to 5 years of age, who were febrile with signs of uncomplicated UTI and presented to one of five emergency departments. Thirteen percent of the participants had vesicoureteral reflux. The children were randomized, using concealed allocation, to receive oral amoxicillin/clavulanate for 5 days or 10 days. Randomization occurred after 3 to 4 days of therapy, when culture results were known, so that investigators could balance the two groups with regard to non–Escherichia coli causes. The study used a noninferior approach to determine whether 5 days of treatment produces worse results than 10 days of therapy. Using intention-to-treat analysis, resolution of symptoms occurred in more than 90% of participants in both groups, and the need for further antibiotic therapy was similar in both groups. Recurrence within 30 days occurred in 2.8% of children with 5 days of treatment and 14.3% of children with 10 days of treatment. Adverse events were reported in a small number of participants in both groups.