Is shortened treatment for urinary tract infections a good idea?

In children without fever at presentation of a urinary tract infection (UTI), treatment with a shorter-than-usual course (2-5 days) of antimicrobials seems “reasonable,” according to a new meta-analysis of short- vs standard-course antimicrobial therapy in UTIs. Of the 9 included studies, 2 have been published since the last meta-analysis of this issue.

Indeed, compared with children prescribed a standard antimicrobial course (6-14 days), those treated with a shortened course (examined in 2 studies) had only an insignificant 2.2% higher risk of UTI when therapy was completed. Further, even in febrile children, this risk did not differ significantly in children who received a short- vs standard-duration treatment. As to the presence of bacteriuria at the end of therapy, which 8 studies addressed, children treated with a short course of an antimicrobial had only an 8.7% higher risk of bacteriuria at the end of therapy than those treated with a standard course. Finally, in children with fever at baseline (addressed in 2 studies), the risk of bacteriuria was similar with short- and standard-duration treatment.

Thoughts from Dr Farber

When I started in pediatrics, virtually every antibiotic course lasted 10 days, presumably as a result of studies in rheumatic fever in the 1950s, rather than actual scientific study. I am all for shorter courses, although I am not sure I will be ready to go to only 2 days for afebrile UTIs just yet.

Reference

Mueller GD, Conway SJ, Gibeau A, Shaikh N. Short- versus standard-course antimicrobial therapy for children with urinary tract infection: a meta-analysis. Acta Paediatr. 2025;114(3):479-486. doi:10.1111/apa.17546