Pediatric UTI: long-term antibiotics yield small benefit in Cochrane review

  • Cochrane Database Syst Rev

  • International Clinical Digest
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Takeaway

  • In children with repeated symptomatic urinary tract infection (UTI), long-term, low-dose antibiotics show small benefit.
  • This course should be reserved for patients at high risk, such as infants or children with renal abnormalities, say the authors of this Cochrane review.

Why this matters

  • The debate continues over the best use, if any, of low-dose, long-term antibiotics in pediatric UTI.
  • This review updates a 2011 version , leaving conclusions unchanged.

Key results

  • Bias risk was high in at least 1 domain in 15 of the 16 included studies.
  • Most bias risk was unclear because of poorly reported methodology.
  • Some risk reduction seen with antibiotics vs placebo/no treatment, but the estimates are uncertain, and the CI indicates low precision:
    • Risk ratio: 0.75 (95% CI, 0.28-1.98).
  • When only studies blinded to randomization were included, the risk ratio was similar at 0.68, with a more convincing CI (95% CI, 0.48-0.95).
  • Adverse event findings were inconsistent.
  • Some findings suggested role of prophylaxis in increased risk for resistant bacteria.

Study design

  • 16 studies included, with 2036 children.
  • Funding: The Children's Hospital Fund Clinical Research Grant, Australia; National Health and Medical Research Council, Australia; Australian Kidney Foundation.

Limitations

  • Uncertain bias, limitations of included studies.

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