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Antibiotic Treatment of Urinary Tract Infections in Infants
Abstract & Commentary
By Hal B. Jenson, MD, FAAP Professor of Pediatrics, Tufts University School of Medicine, and Chief Academic Officer, Baystate Medical Center, Springfield, MA, is Associate Editor for Infectious Disease Alert.
Dr. Jenson reports no financial relationships relevant to this field of study.
Synopsis: A retrospective study of 12,333 infants < 6 months of age with urinary tract infections showed no difference in treatment failure between short-course (≤ 3 days) and long-course (≥ 4 days) of antibiotic therapy.
Source: Brady PW, Conway PH, Goudie A. Length of intravenous antibiotic therapy and treatment failure in infants with urinary tract infections. Pediatrics. 2010;126:196-203.
A retrospective cohort study was conducted of infants < 6 months of age hospitalized with urinary tract infections between 1999 and 2004 at 24 children's hospitals in the United States. Of the 12,333 infants who met inclusion criteria, 240 (1.9%) experienced treatment failure, defined as readmission with urinary tract infection within 30 days. The treatment failure rate was 1.6% for children receiving short-course (≤ 3 days) intravenous treatment and 2.2% for long-course (≥ 4 days) intravenous treatment. There was not a significant association of the duration of antibiotic therapy and treatment failure comparing short- and long-course (adjusted odds ratio: 1.02; 95% CI: 0.77-1.35) or modeling antibiotic therapy as a continuous variable. The only covariates that were significantly associated with treatment failure were severity of illness and the presence of known genitourinary abnormalities.
The proportion of children receiving a long-course (≥ 4 days) of intravenous antibiotic therapy varied significantly among the 24 children's hospitals, ranging from 15% to 87% (p < 0.001).
In this very large cohort study, treatment failure of urinary tract infections among infants < 6 months of age was relatively uncommon approximately 2%. Neither younger age nor short-course (≤ 3 days) duration of antibiotic treatment were risk factors for treatment failure. These results indicate that young infants with urinary tract infections may be successfully treated with short-course (three days) intravenous antibiotic treatment without a significantly increased risk of treatment failure. Severity of illness and the presence of known abnormalities of the genitourinary tract are associated with increased risk of treatment failure and, if present, support a longer course of antibiotic treatment.
There was remarkable variation of the duration of antibiotic therapy across the 24 hospitals that was not explained by patient characteristics. This most likely represents the absence of firm, well-accepted evidence to guide clinical practices and practice guidelines.