answer 1:
There is no significant difference between a short-term and the usual 7-14 day antibiotic treatment. Short- term antibiotic treatment appears to be as effective as 7-14 days in treating UTI. This is supported by the study made by Selma Mizouni, M.D 2006
Report by: Selma Mizouni, M.D
Institution: EVMS
Date submitted: November 27th 2006
Three Part Question:
P: In a patient with acute UTI symptoms
I: Is a three days of oral ABX
C: Compared to five or seven days
O: Associated with lower cure rate?
Clinical scenario
A 42 years old woman diagnosed with a uncomplicated UTI and you want to prescibe a antibiotic. You
wonder whether a short 2-3 day course is better than longer 7-14 day course of antibiotics.
Search strategy
Medline database 1966 to present.
The Cochrane Library 2006
Search outcome
Five metanalysis were identified as answering the 3 part question, found also in Cochrane
Urinary tract infection (UTI) refers to the presence of a certain threshold number of bacteria in the
urine.
Bacterial cystitis (bacteria in the bladder, also called acute cystitis) can occur in men and women
and the signs and symptoms include dysuria (pain on passing urine), frequency, cloudy urine,
occasionally haematuria (blood in the urine), and is often associated with pyuria (high urine white
blood cell count).
Complicated UTIs are those associated with fever and/or back pain (indicating kidney infection),
UTIs in men, UTIs associated with indwelling or intermittent urinary catheters, obstructive
uropathy (any changes in the urinary tract due to obstruction), vesicoureteric reflux (urine travels
from the bladder back up toward the kidneys) and other urological abnormalities.
Comment(s)
This review addresses the three-part question directly and concludes that a short course of treatment is an
effective choice in the treatment of childhood UTI and uncomplicated UTI.
Clinical bottom line
1. 3 days of ABX in uncomplicated UTI in women 18-65 is sufficient.
2. 3 days of ABX in uncomplicated UTI in children 3 months-3 years is sufficient.
3. The verdict is still out there for pregnant woman. Treat for 5-7 days until new data.
4. Treat elderly woman with uncomplicated UTI with a short course of ABX. One single dose is not
yet acceptable despite the benefits of reducing side effects.
5. Anyone with a complicated UTI should get a longer course of ABX.
References
1. Michael M, Hodson EM, Craig JC, Martin S, Moyer VA Short versus standard duration oral
antibiotic therapy for acute urinary tract infection in children (Review) The Cochrane Database of
Systematic Reviews 20 January 2003, Issue 1. Art. No.:CD003966.DOI:
10.1002/14651858.CD003966
2. Milo G, Katchman EA, Paul M, Christiaens T, Baerheim A, Leibovici L Duration of
antibacterial treatment for uncomplicated urinary tract infection in women Milo G,
Katchman EA, Paul M, Christiaens T, Baerheim A, Leibovici LThe Cochrane Database of
Systematic Reviews 2006 Issue 4 Copyright
2006 The Cochrane Collaboration
3. Treatments for symptomatic urinary tract infections during pregnancy Vazquez JC, Villar J
4. Antibiotics for preventing recurrent urinary tract infection in non-pregnant womenAlbert
X, Huertas I, Pereiró I, Sanfélix J, Gosalbes V, Perrota C
5. Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections
in elderly women Lutters M, Vogt-Ferrier NB
answer 2:
PURPOSE OF REVIEW: Urinary tract infection (UTI) in children is common (5-10%) and recurs in 10-30%. UTI causes an unpleasant, usually febrile illness in children. This review focuses on studies evaluating interventions to prevent UTI in children and published between January 2007 and June 2008. RECENT FINDINGS: Three relevant updated Cochrane reviews, six randomized trials and an evidence-based guideline were published in the study period. Five of the six trials and one of the three Cochrane updates included data on the effects of relevant interventions in children. Three of the six trials investigated the efficacy of long-term, low-dose antibiotics as prophylaxis, and the other trials and both Cochrane updates evaluated complementary therapies such as vitamin A, probiotics and herbal supplements. SUMMARY: The benefit of prophylactic antibiotics for the prevention of recurrent UTI in children remains unclear because of underpowered and suboptimally designed trials, but these studies suggest that any benefit is likely to be small, and clinical significance may be limited. The trials of complementary interventions (vitamin A, probiotics, cranberry, nasturtium and horseradish) generally gave favourable results but were not conclusive. Children and families who use these products should be aware that further infections are possible despite their use.