Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial

Febrile urinary tract infection (fUTI) in well-appearing children is conventionally treated with a standard 10-day course of oral antibiotic. The objective of this study is to determine the noninferiority (5% threshold) of a 5-day amoxicillin-clavulanate course compared with a 10-day regimen to trea...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2024-01, Vol.153 (1), p.1
Main Authors: Montini, Giovanni, Tessitore, Antimo, Console, Karen, Ronfani, Luca, Barbi, Egidio, Pennesi, Marco
Format: Article
Language:English
Subjects:
Amoxicillin
Antibiotics
Children
Clavulanic acid
Pediatrics
Recurrent infection
Urinary tract
Urinary tract diseases
Urinary tract infections
Urogenital system
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Summary:Febrile urinary tract infection (fUTI) in well-appearing children is conventionally treated with a standard 10-day course of oral antibiotic. The objective of this study is to determine the noninferiority (5% threshold) of a 5-day amoxicillin-clavulanate course compared with a 10-day regimen to treat fUTIs. This is a multicenter, investigator-initiated, parallel-group, randomized, controlled trial. We randomly assigned children aged 3 months to 5 years with a noncomplicated fUTI to receive amoxicillin-clavulanate 50 + 7.12 mg/kg/day orally in 3 divided doses for 5 or 10 days. The primary end point was the recurrence of a urinary tract infection within 30 days after the completion of therapy. Secondary end points were the difference in prevalence of clinical recovery, adverse drug-related events, and resistance to amoxicillin-clavulanic acid and/or to other antibiotics when a recurrent infection occurred. From May 2020 through September 2022, 175 children were assessed for eligibility and 142 underwent randomization. The recurrence rate within 30 days of the end of therapy was 2.8% (2/72) in the short group and 14.3% (10/70) in the standard group. The difference between the 2 groups was -11.51% (95% confidence interval, -20.54 to -2.47). The recurrence rate of fUTI within 30 days from the end of therapy was 1.4% (1/72) in the short group and 5.7% (4/70) in the standard group (95% confidence interval, -10.4 to 1.75). This study demonstrates that a 5-day course is noninferior to a 10-day course of oral amoxicillin-clavulanate.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2023-062598