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Comment
. 2023 Aug 1;177(8):782-789.
doi: 10.1001/jamapediatrics.2023.1979.

Short-Course Therapy for Urinary Tract Infections in Children: The SCOUT Randomized Clinical Trial

Theoklis Zaoutis  1 , Nader Shaikh  2 , Brian T Fisher  1 , Susan E Coffin  1 , Sonika Bhatnagar  2 , Kevin J Downes  1 , Jeffrey S Gerber  1 , Timothy R Shope  2 , Judith M Martin  2 , Gysella B Muniz  2 , Michael Green  2 , Jennifer P Nagg  2 , Sage R Myers  1 , Rakesh D Mistry  1 , Shawn O'Connor  1 , Walter Faig  1 , Stephen Black  3 , Elizabeth Rowley  3 , Kellie Liston  1 , Alejandro Hoberman  2
Affiliations
Comment

Short-Course Therapy for Urinary Tract Infections in Children: The SCOUT Randomized Clinical Trial

Theoklis Zaoutis et al. JAMA Pediatr. .

Erratum in

  • Errors in Results and Table 2.
    [No authors listed] [No authors listed] JAMA Pediatr. 2024 Jun 1;178(6):630. doi: 10.1001/jamapediatrics.2024.0973. JAMA Pediatr. 2024. PMID: 38619852 Free PMC article. No abstract available.

Abstract

Importance: There is a paucity of pediatric-specific comparative data to guide duration of therapy recommendations in children with urinary tract infection (UTI).

Objective: To compare the efficacy of standard-course and short-course therapy for children with UTI.

Design, setting, participants: The Short Course Therapy for Urinary Tract Infections (SCOUT) randomized clinical noninferiority trial took place at outpatient clinics and emergency departments at 2 children's hospitals from May 2012, through, August 2019. Data were analyzed from January 2020, through, February 2023. Participants included children aged 2 months to 10 years with UTI exhibiting clinical improvement after 5 days of antimicrobials.

Intervention: Another 5 days of antimicrobials (standard-course therapy) or 5 days of placebo (short-course therapy).

Main outcome measures: The primary outcome, treatment failure, was defined as symptomatic UTI at or before the first follow-up visit (day 11 to 14). Secondary outcomes included UTI after the first follow-up visit, asymptomatic bacteriuria, positive urine culture, and gastrointestinal colonization with resistant organisms.

Results: Analysis for the primary outcome included 664 randomized children (639 female [96%]; median age, 4 years). Among children evaluable for the primary outcome, 2 of 328 assigned to standard-course (0.6%) and 14 of 336 assigned to short-course (4.2%) had a treatment failure (absolute difference of 3.6% with upper bound 95% CI of 5.5.%). Children receiving short-course therapy were more likely to have asymptomatic bacteriuria or a positive urine culture at or by the first follow-up visit. There were no differences between groups in rates of UTI after the first follow-up visit, incidence of adverse events, or incidence of gastrointestinal colonization with resistant organisms.

Conclusions and relevance: In this randomized clinical trial, children assigned to standard-course therapy had lower rates of treatment failure than children assigned to short-course therapy. However, the low failure rate of short-course therapy suggests that it could be considered as a reasonable option for children exhibiting clinical improvement after 5 days of antimicrobial treatment.

Trial registration: ClinicalTrials.gov Identifier: NCT01595529.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Shaikh reported grants from the National Institute of Allergy and Infectious Diseases during the conduct of the study. Dr Fisher reported grants from the National Institutes of Health during the conduct of the study, personal fees from Astellas, and grants from Pfizer and Merck outside the submitted work. Dr Coffin reported grants and personal fees from Merck outside the submitted work. Dr Downes reported grants from the National Institutes of Health during the conduct of the study and grants from the National Institute of Child Health and Human Development outside the submitted work. Dr Martin reported grants from the National Institute of Allergy and Infectious Diseases to the institution during the conduct of the study and consultant fees from Merck, Sharp, and Dohme outside the submitted work. Dr Myers reported grants from the National Institute of Allergy and Infectious Diseases during the conduct of the study. Dr Hoberman reported contract fees from the National Institute of Allergy and Infectious Diseases during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Enrollment, Randomization, and Follow-up of Children in the Trial
UTI indicates urinary tract infection.
See this image and copyright information in PMC

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References

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