In pediatric patients, the duration of antibiotic treatment for uncomplicated urinary tract infection (UTI) was not significantly associated with UTI recurrence, according to the findings of a recently conducted retrospective cohort analysis.
To better understand the impact antibiotic treatment duration has on recurrence rates, study authors used the Truven Health MarketScan Database (2013-2015) to obtain data on pediatric patients aged 2-17 years with new-onset cystitis or pyelonephritis not caused by a renal or anatomical abnormality. Of the total 7698 patients included in the study, 85.5% had cystitis and 14.3% had pyelonephritis.
Antibiotic treatment durations were reported to be 3-5 days for cystitis (20.4%), and 7 (33.6%), 10 (44.2%), or 14 (1.8%) days for any UTI. Data analysis revealed that 5.5% of patients had a recurrent UTI, defined as either a relapse (measured from the oral antibiotic depletion date through the subsequent 14 days) or reinfection (measured 15-30 days after depletion).
According to the study findings, several factors were associated with an increased risk of UTI recurrence. These included antibiotic exposure prior to treatment (odds ratio [OR], 1.29; 95% CI, 1.06-1.57), pyelonephritis on diagnosis date (OR, 1.44; 95% CI, 1.03-2.00), having a follow-up visit during antibiotic treatment (OR, 3.21; 95% CI, 2.20-4.68), receiving parenteral antibiotics (OR, 1.89; 95% CI, 1.33-2.69), and the interaction of pyelonephritis diagnosis with nitrofurantoin monotherapy (OR, 3.68; 95% CI, 1.20-11.29), which is know to be ineffective for this condition. Of note, the regimen associated with the highest relapse and reinfection rates was found to be the combination of parenteral and oral cephalosporin.
With regard to antibiotic duration, results of the study showed that after adjusting for covariates, rates of UTI recurrence were not significantly different with shorter and longer treatment regimens (compared with 7 days: 10 days: OR 1.07, 95% CI, 0.85-1.33; 14 days: OR 0.89, 95% CI, 0.45-1.78). “This lack of a significant difference among the measured antibiotic treatment durations lends support to a shortened duration of 7 days of antibiotic therapy as a suitable option for uncomplicated UTI in children aged 2 to 17 years, adding to the currently available base of evidence to guide treatment duration decisions for pediatric UTI,” the authors concluded.
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