Comparison of 3-day versus 14-day treatment of lower urinary tract infection in children. The length of antimicrobial therapy in upper vs. lower urinary tract infection of childhood. Optimal duration of antibiotic therapy for uncomplicated urinary tract infection in older women: a double-blind randomized controlled trial. Duration of treatment for urinary tract infections in children. Short-term treatment of lower urinary tract infections in children with trimethoprim/sulphadiazine. A multicenter, randomized, double-blind trial of 5 versus 10 days of antibiotic therapy for acute otitis media in young children. Five vs. ten days of antibiotic therapy for acute otitis media in young children. Two-day therapy with cefuroxime axetil is effective for urinary tract infections in children. Oral versus initial intravenous therapy for urinary tract infections in young febrile children.
A total of 87 children were treated for lower urinary tract infection. The infection site was determined on the basis of symptoms and laboratory findings. The patients were assigned to four groups, medicated for 3 and for 14 days with nitrofurantoin or cotrimazole. Results from the short and long-term therapies have not shown any significant differences: 9 out of 43 patients in the 3-day therapy group and 8 out of 44 in the 14-day group presented recurrences within one month. 235 infants and children were randomized to a 10-day and 42-day treatment group and followed-up for 12 months after their first urinary tract infection. The anatomical level of each symptomatic infection was determined using simple laboratory criteria. The two regimens prescribed were equally effective in eradicating the infection, but after the discontinuation of the 10-day treatment with sulfafurazole, 17 (23%) of 73 patients with their upper urinary tract infection experienced a recurrence within one month, as compared to only one (1) of 76 subjects in the 42-day therapy group. After the phase of early recurrence, there was no difference in recurrence rate between these groups. The early recurrences were associated with the patient's early age and a short duration of symptoms before therapy. The recurrence rate of first lower UTI after 10-day therapy was significantly lower than that after 42-day treatment. The duration of antimicrobial therapy for childhood urinary tract infection should be adjusted according to the patient's age and the anatomical level of the infection. 10-day treatment may not be sufficient to prevent early recurrence of pyelonephritic infections in infants under 6 months of age. The optimal duration of antibiotic therapy in older patients with uncomplicated urinary tract infection (UTI) is still a matter of debate. The aim of this randomized controlled double-blind noninferiority trial was to compare the efficacy and safety of 3-day and 7-day courses of oral ciprofloxacin for uncomplicated symptomatic UTI in older women.
                A total of 183 women at least 65 years of age with acute uncomplicated UTI were recruited from ambulatory clinics and hospital acute care units. Patients with pyelonephritis, contraindications to fluoroquinolones, recent use of antibiotics, urinary tract abnormalities and diabetes mellitus were excluded. Women were randomly assigned to receive either ciprofloxacin 250 mg twice daily orally for 3 days followed by placebo for 4 days (the 3-day group, 93 patients) or ciprofloxacin 250 mg twice daily orally for 7 days (the 7-day group, 90 patients). Bacterial eradication, clinical improvement and occurrence of adverse events were determined 2 days after completion of treatment, and occurrence of reinfection or relapse were determined 6 weeks after completion of treatment. Bacterial eradication and relapse were determined by urine culture. Double-blind procedures were maintained throughout data collection.
                The proportion of patients with bacterial eradication at 2 days after treatment was 98% (91/93) in the 3-day group and 93% (83/89) in the 7-day group (p = 0.16). The frequency of adverse events, including drowsiness, headache, nausea or vomiting, and loss of appetite, was significantly lower in the 3-day group.
                These results suggest that a 3-day course of antibiotic therapy is not inferior to a 7-day course for treatment of uncomplicated symptomatic UTI in older women, and that the shorter course is better tolerated. In a double-blind trial 45 children aged 6 months to 14 years with Escherichia coli infections of the urinary tract were given co-trimoxazole for two weeks and then allotted at random to one of two treatment groups for the remainder of six months; one continued with the active drug and the other with dummy tablets of identical appearance. Of the 24 children who took co-trimoxazole for two weeks and the 21 who took it for six months, 11 and 10, respectively, remained without further infections for at least a year. Over 90% of the reinfections occurred within five months of stopping the antibiotics, and the longer treatment did not cause any delay in their appearance. Thus probably a six-month course of treatment is no more likely to achieve a cure than a two-week course; nevertheless, no infection occurred during treatment, and there may be an advantage in continuing with antibiotics in small dosage. In a prospective study, 43 children between three months and 16 years of age and suffering from an acute infection of the lower urinary tract, were treated for either three or ten days with 4/16 mg trimethoprim/sulphadiazine/kgBW/day in two doses. Twenty-three were allotted to treatment for three days, whereas 20 were treated for ten days. Irrespective of the duration of therapy, the urine of all patients was sterile when urinary cultures were made three to seven days after the cessation of therapy. An early recurrence within the two months following the completion of treatment occurred in two children in each treatment group. In no case of recurrence was the organism resistant to trimethoprim/sulphadiazine. During a mean follow-up period of 11 months, 21.7% of the children treated for three days and 35% of those treated for ten days experienced a recurrence. The results suggest that children with an uncomplicated lower urinary tract infection can be successfully treated with a three-day course of trimethoprim/sulphadiazine in a conventional dosage. All but 2 of the 15 published trials have failed to show a difference in efficacy between short (3 to 5 days) and standard (7 to 10 days) antibiotic regimens for acute otitis media (AOM). These studies involved relatively few patients under 2 years of age, who are at a higher risk for treatment failure.
                In a prospective, comparative, double-blind, randomized, multicenter trial, we compared amoxicillin/clavulanate in 3 divided doses for 10 days with an identical 5-day regimen, followed by a 5-day placebo period.
                Between February 1995 and May 1996, 385 children (mean age, 13.3 months) were enrolled, 194 in the 5-day treatment group and 191 in the 10-day treatment group. In the per protocol analysis, clinical success was obtained on days 12 to 14 after the beginning of treatment (main analysis) in 125 (76.7%) of the 163 children receiving the 5-day regimen and 148 (88.1%) of the 168 receiving the 10-day regimen (P = .006). Clinical success persisted on days 28 to 42 among 57 (40.4%) of the 141 assessable patients in the 5-day group and 64 (46%) of the 139 assessable patients in the 10-day group. (P = .34). Multivariate analysis showed that the 10-day course was statistically superior only among children cared for outside their homes (86.8% vs 70.8%; P = .008).
                When assessed on days 12 to 14 after the outset of treatment, a 5-day regimen is not equivalent to a 10-day regimen among young children with AOM. Many publications in recent years have argued in favor of shortened therapy for acute otitis media. However, doubt persists regarding children younger than 2 years, and some authors therefore restrict short course therapy to children older than 2 years.
                In a prospective, comparative, double blind, randomized, multicenter trial we compared cefpodoxime-proxetil, 8 mg/kg/day in two divided doses for 10 days, with an identical 5-day regimen followed by a 5-day placebo period.
                Between October, 1996, and April, 1997, 450 children (mean age, 14.3 months) were enrolled, 227 in the 5-day group and 223 in the 10-day group. In the per protocol analysis clinical success was obtained on Days 12 to 14 after the beginning of treatment (main analysis) in 175 (84.1%) of the 208 children receiving the 5-day regimen and 194 (92.4%) of the 210 children receiving the 10-day regimen (P = 0.009). The superiority of the standard regimen was more marked among children cared for outside their homes (92.5% vs. 81.5%). Clinical success persisted on Days 28 to 42 among 134 (85.4%) of the 157 assessable patients in the 5-day group and 144 (83.7%) of the 172 assessable patients in the 10-day group (P = 0.68).
                The 10-day regimen resulted in a higher success rate at the conclusion of therapy, but there were no differences between the two study groups 4 to 6 weeks after enrollment in the study protocol. Short-course therapy for pediatric urinary tract infection (UTI) remains controversial. The present study was undertaken to compare the effectiveness of cefuroxime axetil (Ceftin) as short-course (2-day) versus conventional (10-day) therapy for uncomplicated pediatric UTIs. In a randomized, controlled, prospective study, we enrolled 50 children, 2-11 years of age, to receive oral cefuroxime axetil, 125 mg twice a day, for either 2 or 10 days. UTI was defined as at least 10(5) colonies/ml of a single pathogen isolated on clean catch, or at least 10(4) colonies/ml on a catheterized specimen. A 10-fold or greater reduction in colony count of the initially isolated organism (3-5) days after stopping therapy was considered a bacteriologic success, as long as the absolute colony count was below the threshold for UTI described above. Patients were followed for 15 months with multiple repeat urine cultures and radiologic studies. Twenty-five of the 50 patients enrolled were withdrawn, including 12 for initially inadequate colony counts. Eight of 12 patients in the short-course group (67%), versus 12 of 14 in the conventional-therapy group (86%), were initial bacteriological successes, a nonsignificant difference. All 37 initially isolated uropathogens were sensitive to cefuroxime axetil in vitro. Cefuroxime axetil is an effective antimicrobial for uncomplicated pediatric UTIs. Two-day therapy with cefuroxime axetil appears to be as effective as 10-day therapy, although sample size was limited in this study. The standard recommendation for treatment of young, febrile children with urinary tract infection has been hospitalization for intravenous antimicrobials. The availability of potent, oral, third-generation cephalosporins as well as interest in cost containment and avoidance of nosocomial risks prompted evaluation of the safety and efficacy of outpatient therapy.
                In a multicenter, randomized clinical trial, we evaluated the efficacy of oral versus initial intravenous therapy in 306 children 1 to 24 months old with fever and urinary tract infection, in terms of short-term clinical outcomes (sterilization of the urine and defervescence) and long-term morbidity (incidence of reinfection and incidence and extent of renal scarring documented at 6 months by 99mTc-dimercaptosuccinic acid renal scans). Children received either oral cefixime for 14 days (double dose on day 1) or initial intravenous cefotaxime for 3 days followed by oral cefixime for 11 days.
                Treatment groups were comparable regarding demographic, clinical, and laboratory characteristics. Bacteremia was present in 3.4% of children treated orally and 5.3% of children treated intravenously. Of the short-term outcomes, 1) repeat urine cultures were sterile within 24 hours in all children, and 2) mean time to defervescence was 25 and 24 hours for children treated orally and intravenously, respectively. Of the long-term outcomes, 1) symptomatic reinfections occurred in 4.6% of children treated orally and 7.2% of children treated intravenously, 2) renal scarring at 6 months was noted in 9.8% children treated orally versus 7.2% of children treated intravenously, and 3) mean extent of scarring was approximately 8% in both treatment groups. Mean costs were at least twofold higher for children treated intravenously ($3577 vs $1473) compared with those treated orally.
                Oral cefixime can be recommended as a safe and effective treatment for children with fever and urinary tract infection. Use of cefixime will result in substantial reductions of health care expenditures.
A 2-4 day course of oral antibiotics appears to be as effective as 7-14 days in eradicating lower tract UTI in children.