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Meta-Analysis
. 2012 Aug 15;2012(8):CD006857.
doi: 10.1002/14651858.CD006857.pub2.

Antibiotics for treating lower urinary tract infection in children

Anita Fitzgerald  1 , Rintaro Mori, Monica Lakhanpaul, Kjell Tullus
Affiliations
Meta-Analysis

Antibiotics for treating lower urinary tract infection in children

Anita Fitzgerald et al. Cochrane Database Syst Rev. .

Abstract

Background: Urinary tract infection (UTI) is one of the most common bacterial infections in infants and children. Lower UTI is the most commonly presenting and in the majority of cases can be easily treated with a course of antibiotic therapy with no further complications. A number of antimicrobials have been used to treat children with lower UTIs; however is it unclear what are the specific benefits and harms of such treatments.

Objectives: This review aims to summarise the benefits and harms of antibiotics for treating lower UTI in children.

Search methods: We searched the Renal Group's Specialised Register (April 2012), CENTRAL (The Cochrane Library 2012, Issue 5), MEDLINE OVID SP (from 1966), and EMBASE OVID SP (from 1988) without language restriction. Date of last search: May 2012.

Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs in which antibiotic therapy was used to treat bacteriologically proven, symptomatic, lower UTI in children aged zero to 18 years in primary and community healthcare settings were included.

Data collection and analysis: Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratios (RR) with 95% confidence intervals (CI).

Main results: Sixteen RCTs, analysing 1,116 children were included. Conventional 10-day antibiotic treatment significantly increased the number of children free of persistent bacteriuria compared to single-dose therapy (6 studies, 228 children: RR 2.01, 95%CI 1.06 to 3.80). No heterogeneity was observed. Persistent bacteriuria at the end of treatment was reported in 24% of children receiving single-dose therapy compared to 10% of children who were randomised to 10-day therapy. There were no significant differences between groups for persistent symptoms, recurrence following treatment, or re-infection following treatment. There was insufficient data to analyse the effect of antibiotics on renal parenchymal damage, compliance, development of resistant organisms or adverse events. Despite the inclusion of 16 RCTs, methodological weakness and small sample sizes made it difficult to conclude if any of the included antibiotics or regimens were superior to another.

Authors' conclusions: Although antibiotic treatment is effective for children with UTI, there are insufficient data to answer the question of which type of antibiotic or which duration is most effective to treat symptomatic lower UTI. This review found that 10-day antibiotic treatment is more likely to eliminate bacteria from the urine than single-dose treatments. No differences were observed for persistent bacteriuria, recurrence or re-infection between short and long-course antibiotics where the antibiotic differed between groups. This data adds to an existing Cochrane review comparing short and long-course treatment of the same antibiotic who also reported no evidence of difference between short and long-course antibiotics.

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Conflict of interest statement

  1. Anita Fitzgerald: Some of this work was undertaken when all authors were employed by, or were advisor's to, the National Collaborating Centre for Women’s and Children’s Health which received funding from NICE. The views expressed in this publication are those of the authors and not necessarily those of NICE.

  2. Monica Lakhanpaul: I was the Clinical Director at the National Collaborating Centre for Women's Health and led the development of the NICE Urinary Tract Infection Guideline. I am no longer the Clincial Director but remain on the NCC‐WCH board and i am a NICE Fellow and member of the NHS evidence advisory team.

Figures

1
1
Study flow diagram show study selection process
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Single‐dose versus conventional 10‐day treatment, Outcome 1 Persistent bacteriuria.
1.2
1.2. Analysis
Comparison 1 Single‐dose versus conventional 10‐day treatment, Outcome 2 Persistent symptoms.
1.3
1.3. Analysis
Comparison 1 Single‐dose versus conventional 10‐day treatment, Outcome 3 Recurrence.
1.4
1.4. Analysis
Comparison 1 Single‐dose versus conventional 10‐day treatment, Outcome 4 Persistent bacteriuria and symptoms.
2.1
2.1. Analysis
Comparison 2 Single‐dose versus short‐course (3‐7 days) treatment, Outcome 1 Persistent bacteriuria.
2.2
2.2. Analysis
Comparison 2 Single‐dose versus short‐course (3‐7 days) treatment, Outcome 2 Recurrence.
2.3
2.3. Analysis
Comparison 2 Single‐dose versus short‐course (3‐7 days) treatment, Outcome 3 Re‐infection.
3.1
3.1. Analysis
Comparison 3 Short‐course (3‐7 days) versus long‐course (10‐14 days) treatment, Outcome 1 Persistent bacteriuria.
3.2
3.2. Analysis
Comparison 3 Short‐course (3‐7 days) versus long‐course (10‐14 days) treatment, Outcome 2 Recurrence.
3.3
3.3. Analysis
Comparison 3 Short‐course (3‐7 days) versus long‐course (10‐14 days) treatment, Outcome 3 Re‐infection.
4.1
4.1. Analysis
Comparison 4 Trimethoprim (10 days) versus trimethoprim+sulfamethoxazole (10 days), Outcome 1 Persistent bacteriuria.
4.2
4.2. Analysis
Comparison 4 Trimethoprim (10 days) versus trimethoprim+sulfamethoxazole (10 days), Outcome 2 Persistent symptoms.
4.3
4.3. Analysis
Comparison 4 Trimethoprim (10 days) versus trimethoprim+sulfamethoxazole (10 days), Outcome 3 Recurrence.
5.1
5.1. Analysis
Comparison 5 Cefadroxil (10 days) versus ampicillin (10 days), Outcome 1 Persistent bacteriuria.
5.2
5.2. Analysis
Comparison 5 Cefadroxil (10 days) versus ampicillin (10 days), Outcome 2 Persistent symptoms.
6.1
6.1. Analysis
Comparison 6 Single‐dose fosfomycin versus single‐dose netilmicin, Outcome 1 Persistent bacteriuria.
6.2
6.2. Analysis
Comparison 6 Single‐dose fosfomycin versus single‐dose netilmicin, Outcome 2 Recurrence.
See this image and copyright information in PMC

Comment in

References

References to studies included in this review

Ahmed 2001 {published data only}
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Careddu 1987 {published data only}
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Carlsen 1985 {published data only}
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Dagan 1992 {published data only}
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De Garate 1988 {published data only}
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Ellerstein 1977 {published data only}
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Fuji 1987 {published data only}
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Gaudreault 1992 {published data only}
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Ginsburg 1982 {published data only}
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Gonzalez 1985 {published data only}
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Hayashida 1970 {published data only}
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Helin 1981 {published data only}
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Hoberman 1999 {published data only}
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Howard 1978 {published data only}
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Kenda 1995 {published data only}
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Krepler 1976 {published data only}
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Lohr 1981 {published data only}
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Lubitz 1984 {published data only}
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Madrigal 1988 {published data only}
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Marild 2009 {published data only}
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Palcoux 1986 {published data only}
    1. Palcoux JB, Raynaud EJ, Borderon JC, Dalous A, Geisert J, Pennaforte F, et al. Clinical trial of a clavulanic acid‐amoxicillin combination in urinary infections in children [Essai clinique de l'association acide clavulanique‐amoxicilline dans les infections urinaries de l'enfant]. Annales de Pediatrie 1986;33(8):761‐3. [MEDLINE: ] - PubMed
Pitt 1982 {published data only}
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Pylkkanen 1981 {published data only}
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Stansfeld 1975 {published data only}
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Sullivan 1980 {published data only}
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References to other published versions of this review

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