Research In Practice Blog

Urinary Tract Infections (UTIs) affect 2-8% of all children by age 7, according to CDC. But, despite decades of treatment with antimicrobials, experts disagree on exactly how to care for children suffering from these types of infections. One point of variance is duration of therapy for children with UTIs—sometimes medication is prescribed for 10 days, other times for 5 days.  

The recent patterns of resistance to antibiotics/antimicrobials have highlighted the need for more evidence-based prescribing guidelines that help clinicians ensure minimum necessary childhood exposure to these drugs. So, to help determine the best approach for treating UTIs, five Clinical Futures researchers, along with other experts from Children’s Hospital of Philadelphia and UPMC Children’s Hospital of Pittsburgh, conducted a 7-year randomized controlled study: the Short-Course Therapy for Urinary Tract Infections in Children (SCOUT) trial. 

Study design & findings 

In this study, 664 participants aged 2 months to 10 years who had UTIs and showed clinical improvement after 5 days were included. Participants were then treated with antimicrobial medications for another 5 days (standard-course therapy) or with placebo for 5 days (short-course therapy). Rates of treatment failure were only slightly lower for children receiving short-course therapy than standard-course.  

Implications  

This study showed that longer duration of antimicrobial therapy did not result in meaningfully greater benefit for children with UTIs. While, ultimately, children receiving antimicrobial UTI treatment for a longer duration had lower rates of treatment failure, short-course therapy was successful for most children in this study. Thus, the authors recommend consideration of the shorter, 5-day medication regimen for children who show improvement after 5 days. 

Clinical Futures study authors: Brian T. Fisher, DO; Susan E. Coffin, MD; Kevin J. Downes, MD; Jeffrey S. Gerber, MD; Sage R. Myers, MD; Shawn O’Connor, BS 

Additional study authors from Children’s Hospital of Philadelphia: Theoklis E. Zaoutis, MD, MSCE; Rakesh D. Mistry, MD; Kellie Liston, BA 

Zaoutis T, Shaikh N, Fisher BT, et al. Short-Course Therapy for Urinary Tract Infections in Children: The SCOUT Randomized Clinical Trial. JAMA Pediatr. Published online June 26, 2023. Doi:10.1001/jamapediatrics.2023.1979