THE OPTIMAL duration for antibiotic treatment in children with febrile urinary tract infections (UTIs) remains a topic of ongoing debate. Recent research sought to compare the effectiveness of an individualised treatment strategy with the conventional 10-day course in managing recurrent UTIs and reducing overall antibiotic exposure. The study aimed to assess whether individualised treatment, based on clinical improvement, was superior to the standard approach while offering the added benefit of reducing antibiotic usage. The key finding of the study is that individualised treatment led to a significant reduction in antibiotic days, without compromising the safety of the children involved.
The study was conducted as an open-label, multicentre, randomised controlled trial at eight Danish hospitals. Children aged between 3 months and 12 years who presented with febrile UTIs and significant uropathogenic bacterial growth were randomised to receive either individualised treatment or a standard 10-day antibiotic course. Children in the individualised group received treatment for a minimum of 4 days, stopping once adequate clinical improvement had been achieved, whereas the standard group completed a 10-day regimen. The primary outcomes were recurrent UTIs within 28 days and the total antibiotic days within the same period. Safety assessments were also made, including the incidence of antibiotic-related adverse events.
The results revealed that 11% of children in the individualised treatment group experienced recurrent UTIs within 28 days, compared with 6% in the standard 10-day group. However, the difference was not statistically significant enough to declare the individualised approach non-inferior (p=0.24). In terms of antibiotic exposure, the individualised treatment group had a median of 6 days of antibiotics, compared to 10 days in the standard group (p<0.0001). Furthermore, the individualised approach was associated with a reduced rate of antibiotic-related adverse events, at 6.8 per 100 patient-days versus 11.1 in the standard group (p=0.0003). Serious adverse events were similar in both groups, suggesting no increased risk from the individualised approach.
This study suggests that individualised treatment for febrile UTIs can reduce the duration of antibiotic use and the incidence of adverse events, making it a valuable strategy for reducing unnecessary antibiotic exposure. However, while the individualised treatment did not significantly affect the recurrence of UTIs, further research is needed to better identify which children might require longer treatment durations to avoid any risk of inadequate care.
Reference
Sethi NJ et al. Efficacy and safety of individualised versus standard 10-day antibiotic treatment in children with febrile urinary tract infection (INDI-UTI): a pragmatic, open-label, multicentre, randomised, controlled, non-inferiority trial in Denmark. Lancet Infect Dis. 2025;DOI: 10.1016/S1473-3099(25)00075-1.
