A recent multicenter study found that a 5-day course of amoxicillin-clavulanate is equally effective as the conventional 10-day regimen in treating febrile urinary tract infections (fUTIs) in children. The findings were published in the Journal of Pediatrics.
This investigator-initiated, randomized, controlled trial included children aged 3 months to 5 years with noncomplicated fUTIs. The study was conducted over two years to establish the noninferiority of the shorter antibiotic course by setting a 5% threshold. The participants were assigned randomly to receive either a 5-day or a 10-day oral course of amoxicillin-clavulanate.

The primary endpoint was the recurrence of a urinary tract infection within 30 days after completing therapy. The results revealed a recurrence rate of 2.8% in the 5-day group when compared to 14.3% in the 10-day group. The difference between the two groups were statistically significant at –11.51% (95% confidence interval, –20.54 to –2.47). Also, the recurrence rate of fUTIs within 30 days from the end of therapy was 1.4% in the 5-day group and 5.7% in the 10-day group which further solidifies the noninferiority of the shorter course.
The findings of the study challenges the conventional approach to treating childhood urinary tract infections. The outcomes demonstrate that a 5-day course of oral amoxicillin-clavulanate is noninferior to the standard 10-day course. This has significant implications for clinical practice by potentially allowing for a more streamlined and patient-friendly approach to managing fUTIs in children. The shorter course not only reduces the burden of antibiotic administration but also lowers the risk of antibiotic resistance. This study also opens the door to reconsidering established norms by putting forth a more efficient and equally efficacious treatment option for febrile urinary tract infections in young children.
Source:
Montini, G., Tessitore, A., Console, K., Ronfani, L., Barbi, E., & Pennesi, M. (2023). Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial. In Pediatrics. American Academy of Pediatrics (AAP). https://doi.org/10.1542/peds.2023-062598