July 12, 2023

In The News: Shorter Antibiotic Course Not as Effective for Children With UTIs

Medpage Today reports on a SCOUT (Short Course Therapy for Urinary Tract Infections) trial into antibiotic course duration for children with urinary tract infections. A study author noted the trial was initiated in part because there was little data to guide treatment duration in children compared to adults. Study researchers opted to test a five-day course against a full 10-day course. They found stopping antibiotics after a five-day course yielded a 4.1% rate of persistent symptomatic UTI by follow-up at day 11-14 compared with 0.6% for the full 10-day course.

The study authors did not fully discount the use of a shorter duration antibiotic course. They pointed to the failure rate being low enough to suggest it could be a viable option for children with clinical improvement after five days. The treatment failure rates in a post hoc analysis showed a similar rate, though, of UTI within nine days of treatment discontinuation. Treatment failure was reported to not be related to age, presence of fever, prescribed therapy, or study site.

No differences were noted between the groups in rates of UTI after the first follow-up visit, incidence of adverse events, or incidence of gastrointestinal colonization with resistant organisms. Study limitations included imbalance between treatment groups in number excluded from analysis, antimicrobial resistance was assessed only for Escherichia coli and Klebsiella pneumoniae strains, an absence of data on adherence to originally prescribed antimicrobials on days one to five, lack of strain-level data on recovered uropathogens, and lack of data on outcomes, such as kidney scarring.

The noninferiority trial was conducted at outpatient clinics and emergency departments at two children’s hospitals from May 2012 through August 2019. Participants included children ages 2 months to 10 years with UTI exhibiting clinical improvement after 5 days of antimicrobial therapy. The trial randomized 664 children (96% girls, median age 4 years) to an additional 5 days of antibiotics or placebo.

PIDS members Aaron Milstone and Pranita Tamma wrote an accompanying editorial to the study. Their editorial included, “The SCOUT trial is an important addition to the scientific literature to guide shared decision-making between healthcare professionals and primary caretakers. The slightly increased risk of treatment failure with the added benefit of convenience and potentially less adverse events should be discussed with parents; in this way, they can contribute to conversations surrounding the ultimate duration of therapy prescribed. These conversations should acknowledge signs of clinical failure that would warrant a return to medical care and monitoring of antibiotic-associated adverse events.”

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