Effective antimicrobial therapies of urinary tract infections among children in low‐ and middle‐income countries: A systematic review

• Published in: Pediatric investigation 2023-06, Vol.7 (2), p.102-110
• Main Authors: Ara, Rifat, Nasrullah, Sarker Mohammad, Tasnim, Zarrin, Afrin, Sadia, Hawlader, Mohammad Delwer Hossain, Saif‐Ur‐Rahman, KM
• Format: Article
• Language: English
• Subjects: Age; Antibiotics; Antimicrobial agents; Bacterial infections; Children; Children & youth; Clinical trials; Developing countries; Disease prevention; Drug resistance; Efficacy; Intervention; LDCs; LMICs; Low income groups; Microorganisms; Pathogens; Pediatrics; Systematic Review; Urinary tract diseases; Urinary tract infection; Urinary tract infections; Urogenital system
• ISSN: 2574-2272; 2096-3726; 2574-2272
• DOI: 10.1002/ped4.12375

ABSTRACT Importance Urinary tract infection (UTI) is one of the most common infections encountered in infancy and childhood. Despite the emerging problem of antibiotic resistance in recent years, the use of antibiotics for better management of UTIs is inevitable. Objective This study aims to explore the efficacy and adverse effects of the available antimicrobial agents that are used in pediatric UTIs in low‐ and middle‐income countries (LMICs). Methods Five electronic databases were searched to identify relevant articles. Two reviewers independently performed screening, data extraction, and quality assessment of the available literature. Randomized controlled trials providing antimicrobial interventions in both male and female participants within the age range of 3 months to 17 years in LMICs were included. Results Six randomized controlled trials from 13 LMICs were included in this review (four trials explored the efficacy). Due to high heterogeneity across the studies, a meta‐analysis was not performed. Other than attrition and reporting bias, the risk of bias was moderate to high due to poor study designs. The differences in the efficacy and adverse events of different antimicrobials were not found to be statistically significant. Interpretation This review indicates the necessity for additional clinical trials on children from LMICs with more significant sample numbers, adequate intervention periods, and study design. The systematic review robustly adheres to the PRISMA guidelines and Cochrane Systematic Review methodology. A comprehensive search of five electronic databases allowed reviewing 928 potential studies. In total, we included six RCTs incorporating 511 pediatric patients of both sexes. The reviewed studies were from 13 different LMICs around the globe. The cure rate of the antibiotics ranged from 50% to 92%.