Shorter Course Antibiotics May Be Effective for Pediatric Urinary Tract Infections

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Investigators assert that their results provide support for, without definitively establishing efficacy of, shorter-course antibiotic therapy treatment.
Investigators assert that their results provide support for, without definitively establishing efficacy of, shorter-course antibiotic therapy treatment.
This article is part of Infectious Disease Advisor's coverage of IDWeek 2018, taking place in San Francisco, CA. Our on-site staff will be reporting on the latest breaking research and clinical advances in infectious diseases. Check back regularly for highlights from IDWeek 2018.

SAN FRANSISCO — Rates of urinary tract infection (UTI) recurrence after antibiotic depletion did not differ significantly between treatment durations of 7 days, 10 days, and 14 days, according to research presented at IDWeek 2018, in San Francisco, California.

Researchers in this retrospective cohort analysis investigated the association of antibiotic treatment durations of 7, 10, or 14 days with UTI progression or recurrence in pediatric patients (age 2 to 17). 

They collected data on pediatric patients with primary diagnosis of pyelonephritis or cystitis, or secondary diagnosis as such with primary diagnosis of fever or dysuria, using the Truven Health MarketScan Database claims and eligibility data from 2013 to 2015 (N=7698). Researchers excluded any patients with any renal or anatomic abnormalities, patients who received alternate infection diagnosis, and those who had been hospitalized 3 days prior or post diagnosis of UTI.  Reinfection was defined as UTIs diagnosed 15-30 days after antibiotic depletion, and relapse was defined as UTIs diagnosed 0-14 days after antibiotic depletion. Researchers defined progression as a recurrence diagnosis of pyelonephritis in a patient who was originally diagnosed with only cystitis.

Of the 7698 participants, 14.3% had pyelonephritis and 85.5% had cystitis. Antibiotic treatment durations were 3 to 5 days for only cystitis (20.4%), or 7, 10, or 14 days for any UTI diagnosis (33.6%, 44.2%, and 1.8%, respectively). Progressing infections occurred in .2% of participants, and recurrence in 5.5%. Increased risk of recurrence was linked to interaction of nitrofurantoin with pyelonephritis diagnosis (odds ratio [OR] 3.68; 95% CI, 1.20-11.29), use of nitrofurantoin only (OR 1.34; 95% CI, 1.00-1.92), parenteral antibiotic therapy (OR 1.89; 95% CI, 1.33-2.69), follow-up visit during antibiotic treatment (OR 3.21; 95% CI, 2.20-4.68), pyelonephritis on diagnosis date (OR 1.44; 95% CI, 1.03-2.00), and pretreatment antibiotic exposure (OR 1.29; 95% CI, 1.06-1.57).

After adjustments were made for confounders, the association between antibiotic treatment duration and recurrence was not significant (10 days compared to 7 days: OR 1.07; 95% CI, 0.85-1.33; 14 days compared with 7 days: OR 0.89; 95% CI, 0.45-1.78).

Study investigators concluded that because recurrence rates after antibiotic depletion did not significantly differ between various treatment durations, these "results provide support for, without definitively establishing efficacy of, shorter-course [antibiotic therapy] treatment."

Disclosures: Merck contributed to grant support for Kellie J Goodlet.

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Reference

Afolabi TM, Goodlet KJ, Fairman KA. Association of antibiotic treatment duration with first recurrence of uncomplicated urinary tract infection in pediatric patients. Presented at: IDWeek 2018; October 3-7, 2018; San Francisco, California.

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