Individualized treatment in febrile UTI helps reduce antibiotic exposure, related harms

In the treatment of children with febrile urinary tract infection (UTI), individualized treatment appears to be associated with reduced antibiotic use and fewer adverse event days as compared with standard 10-day treatment, according to a study.

The study included 408 paediatric patients (median age 1.5 years, 80 percent female) who were febrile (≥38 °C) and had significant growth of uropathogenic bacteria. Within 24 h, these patients were randomly assigned to individualized treatment (n=205; median antibiotic duration 5.3) or standard 10-day treatment (n=203). Those in the individualized group discontinued treatment 3 days after adequate clinical improvement (ie, absence of fever, flank pain, and dysuria), with a minimum treatment duration of 4 days.

The primary outcomes were recurrent UTI within 28 days after treatment cessation (noninferiority margin 7.5 percentage points) and total antibiotic days within 28 days of treatment initiation (superiority assessment). Safety was also evaluated.

Within 28 days after treatment cessation, recurrent UTI occurred in 11 percent of patients in the individualized group and in 6 percent in the standard 10-day group (difference 5.3 percentage points, 97.5 percent confidence interval [CI], –∞ to 11.1; p=0.24). Total antibiotic days within 28 days of treatment initiation were 6.0 in the individualized group and 10.0 in the standard 10-day group (median difference, –4.0 days, 97.5 percent CI, –4.5 to –3.7; p<0.0001).

The incidence rate of antibiotic-related adverse events (AEs) within 28 days was 6.8 per 100 patient-days in the individualized group and 11.1 per 100 patient-days in the standard 10-day group (rate ratio, 0.61, 95 percent CI, 0.47–0.80; p=0.0003). Serious AEs occurred in 8 percent of patients in the individualized group and in 7 percent in the standard 10-day group (difference, 0.9 percentage points, 95 percent CI, –4.6 to 6.5; p=0.79).

The present study points to the potential of individualized treatment strategies to reduce antibiotic exposure and associated harms in most children with febrile UTI, supporting antimicrobial stewardship goals.