Standard-course antimicrobial therapy lowers treatment failure in children with UTI

A 10-day standard course of antimicrobial therapy was associated with a lower rate of treatment failure in children with urinary tract infection (UTI) than with a 5-day short course of antimicrobial therapy, according to the SCOUT* trial.

This multicentre, double-blind, noninferiority clinical trial analysed 664 children (median age 4 years, 96 percent female) diagnosed with symptomatic UTI who were prescribed one of the five frequently used antimicrobials** and exhibited clinical improvement after the first 5 days of antimicrobial therapy. Participants were randomly assigned to receive either an additional 5 days of the prescribed antimicrobial agent (standard-course therapy; n=328) or 5 days of placebo (short-course therapy; n=336). [JAMA Pediatr 2023;doi:10.1001/jamapediatrics.2023.1979]

At follow-up, children who received standard-course therapy had a lower rate of treatment failure, which was defined as the occurrence of UTI between day 6 and the day 11-14 visit, than those treated with short-course therapy (0.6 percent vs 4.2 percent).

A lower percentage of children with febrile UTI between day 6 and the day 11-14 visit was observed in the standard-course vs the short-course therapy group (0.3 percent vs 1.8 percent), though these.

With regard to secondary outcomes, children treated with standard-course therapy were significantly less likely to have asymptomatic bacteriuria (3.4 percent vs 8.6 percent; p<0.01) and positive urine culture (1.8 percent vs 12.2 percent; p<0.01) at or before the day 11-14 visit than those treated with short-course therapy. “However, the importance of these findings is unclear. The presence of bacteria in the urine is not necessarily clinically relevant if the child continues to improve and does not go on to have a recurrent infection,” said the researchers.

There were no statistically significant differences between treatment groups on all other secondary endpoints, such as rates of UTI, UTI symptoms, and emergence of antimicrobial resistance.

The incidence of adverse events were also comparable between the standard- and short-course therapy groups (47.3 percent vs 43.8 percent).

In a post hoc analysis, only nine children in the standard-course therapy group had a UTI within 9 days of stopping antimicrobial therapy compared with 14 children in the short-course therapy group.

“According to the findings, 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,” the researchers concluded.