Three-day therapy of lower urinary tract infections with nitrofurantoin macrocrystals: a randomized clinical trial. Short-term treatment of acute urinary tract infection in girls. Copenhagen Study Group of Urinary Tract Infections in Children. Nalidixic acid and trimethoprim/sulphamethoxazole as alternatives for short-term treatment of urinary infections. Two-day therapy with cefuroxime axetil is effective for urinary tract infections in children. Comparison of 3-day versus 14-day treatment of lower urinary tract infection in children. Short-term treatment of lower urinary tract infections in children with trimethoprim/sulphadiazine. Localization and therapy of urinary tract infections of childhood. Single dose antibiotic therapy is not as effective as conventional regimens for management of acute urinary tract infections in children. Single daily doses of trimethoprim/sulphadiazine for three or 10 days in urinary tract infections. The role of bacterial adhesins in the outcome of childhood urinary tract infections.
Forty-nine girls between the ages of 2 and 18 years with a symptomatic urinary tract infection documented by two clean-catch urine cultures completed a double-blind study comparing the effectiveness of three days versus ten days of nitrofurantoin macrocrystal therapy. Localization of the infection to the lower urinary tract was presumed on the basis of clinical presentation. All patients had sterile urine on day two or three of therapy. In the ten-day group, two of 23 patients (8.7%) experienced a single relapse, and seven patients (30%) had 12 episodes of reinfection during a six-month follow-up. In the three-day group, two of 26 patients (7.7%) had a single relapse, and six patients (23%) had 12 episodes of reinfection. The rates of relapse and reinfection in the compared groups were not statistically significantly different (P greater than 0.05). Three days of treatment with nitrofurantoin macrocrystals is an effective regimen for symptomatic girls presumed to have uncomplicated lower urinary tract infections. The efficiency of treatment of acute urinary tract infections with sulfamethizole for 3 days, sulfamethizole for 10 days, and pivmecillinam for 3 days was compared in a randomized multicentre study comprising 264 girls aged 1-15 years. For ethical reasons children with complicated diseases were not included. In these treatment groups no significant growth after treatment was found in 81%, 77%, and 74%, respectively (NS). New bacteria after treatment were found less frequently after sulfamethizole for 3 days (4%) when compared to sulfamethizole for 10 days (14%) and pivmecillinam for 3 days (13%) (p = 0.048). After pivmecillinam treatment 75% of new bacteria were Streptococcus faecalis versus 25% after sulfamethizole for 3 days and 18% after sulfamethizole for 10 days (p = 0.016). In the subgroup with nephro-urological abnormalities no significant growth after treatment was found in 68% of the sulfamethizole 3-day treated group, 54% of the sulfamethizole 10-day treated group, and 67% of the pivmecillinam 3-day treated group (NS). All treatments resulted in a change in the bacterial sensitivity pattern when bacteria isolated 1-10 days after treatment was compared to those found before treatment. This was more pronounced after the 10-day treatment when compared to the 3-day treatment. The sensitivity patterns of the bacteria isolated from recurrences were similar to those seen before treatment. After treatment there was no difference in the actuarial percentage recurrence-free curves of the 3 treatment groups. Side effects were rare in the sulfamethizole treated groups, and seen more often in the pivmecillinam treated group. 3-day treatment with sulfamethizole or alternatively pivmecillinam is recommended as first choice for treatment of uncomplicated acute urinary tract infections in girls. The efficacy of 3-day therapy with nalidixic acid in 16 children, and trimethoprim/sulphamethoxazole in 19 children, was studied prospectively in children with an acute infection of the lower urinary tract and compared with that of a conventional 10-day course with the same drugs. The immediate cure rate was 97% in the 3-day group and 90% in the 10-day group. During 3 months of follow-up there were altogether six re-infections in children given short-term treatment and six in the conventionally treated group. The results give further support for the suggestion that 3-day therapy is equivalent to 10-day treatment in uncomplicated urinary infections in children and that both nalidixic acid and trimethoprim/sulphamethoxazole are good alternatives in such an approach. 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. 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. 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. One hundred four patients with 124 episodes of urinary tract infection were studied. Serum C-reactive protein (CRP) was determined on diagnosis of each patient. Children with a CRP equal to or greater than 30 micrograms/ml (CRP-pos) differed significantly from those with values less than 30 micrograms/ml (CRP-neg) in age, clinical presentation, K type of Escherichia coli causing disease, frequency or radiographic abnormalities, and presence of antibody coating of bacteria in the urinary sediment. E. coli K1 strains caused disease significantly more often in CRP-pos than in CRP-neg patients, and children with K1 infections were younger than those with non-K1 infections. The antibody-coated bacteria test was neither sensitive nor specific for localization of infection in pediatric patients. Determination of K1 antibody concentrations in serum and urine of E. coli K1-infected children provided data supporting the measurement of CRP as one means of localizing urinary tract infections. Patients with CRP-neg infections were treated as successfully with four days of antimicrobial therapy as with ten days. One hundred thirty-two children with acute urinary tract infection were randomly assigned to receive trimethoprim-sulfamethoxazole in one dose, two doses daily for 3 days or two doses daily for 7 days. The patient characteristics, etiologic agents and frequency of roentgenologic abnormalities were similar for the three treatment groups. There was no significant difference in bacteriologic cure rates for the single dose regimen (93%) and multidose regimens (96%). The difference in rates of recurrent urinary tract infection between the single dose (20.5%) and 3-day (5.6%) and 7-day (8%) regimens was statistically significant (P = 0.033). A single dose of trimethoprim-sulfamethoxazole is inadequate treatment for infants and children with acute urinary tract infection. We conducted a prospective randomized study to evaluate the efficacy of a single daily dose of 4 mg/kg of trimethoprim coupled with 17.5 mg/kg of sulphadiazine for three (group 1) or 10 days (group 2) in the treatment of uncomplicated urinary tract infections in children. Forty patients (nine boys and 31 girls) aged 2.5-18 years, presenting with a urinary tract infection were allocated to one of the two groups. Patients were seen three, 10, and > or = 38 days after the initiation of treatment. Control urine cultures were negative in all patients at days 3 and 10. Two patients in group 1 and one patient in group 2 suffered a relapse within a month. Single doses of trimethoprim/sulphadiazine for three or 10 days are effective in the treatment of uncomplicated urinary tract infections in children. To compare the efficacy of 3-day vs 10-day treatment with a combination of amoxicillin and clavulanate potassium for children with uncomplicated urinary tract infections and to determine the role of host factors, including vesicoureteral reflux, and of bacterial virulence factors, including adhesins, in treatment outcome.
                Randomized, double-blind, controlled trial.
                A pediatric infectious diseases clinic at an urban medical center.
                Thirty-seven children with uncomplicated urinary tract infections.
                Treatment with 3 days or 10 days of antibiotics at a dosage of 20 mg/kg per day of amoxicillin and 5 mg/kg per day of clavulanate potassium in three divided doses.
                The success rate for 10-day treatment was 82% (14/17) compared with 55% (11/20) for 3-day treatment (P = .09). Among the 35 patients infected with Escherichia coli, all 10 patients infected with adhesin-negative isolates were treated successfully regardless of the duration of treatment, whereas only 14 (56%) of the 25 infections involving adhesin-positive isolates were clinically cured (P = .015). Two of the three failures in the 10-day treatment group were in patients with reflux.
                We conclude that 3-day treatment with amoxicillin and clavulanate is insufficient for afebrile childhood urinary tract infections and that both bacterial and host factors affect treatment outcome.
A 2-4 day course of oral antibiotics appears to be as effective as 7-14 days in eradicating lower tract UTI in children.