SHORT COURSE VERSUS LONG COURSE OF ORAL ANTIBIOTICS IN PATIENTS WITH UTI

Abstract

Background: Urinary tract infection (UTI) is a type of bacterial infection that is one of the most frequently occurring in children and is a leading cause of outpatient care and antibiotic prescriptions worldwide. Though the main source of treatment is oral antibiotics, the length of the therapy course is a controversial issue as shorter courses might be more effective in improving adherence and preventing antimicrobial exposure, but longer courses might be more effective in terms of bacterial elimination and reduced relapse. Aim: To determine the effectiveness of short-course (3 days) and long-course (5 days) oral cefixime treatment in children with first-episode symptomatic UTI. Methods: This analytical cross-sectional study involved 30 children aged between 2 and 18 years and were first-episode symptomatic UTI with a visit to the pediatric medicine outpatient. Participants were separated into two groups of children (15 children in each group). Short course group was treated to oral cefixime (10 mg/kg/day) over 3 days and the long course group was treated to the same dose over 5 days. Demographic and clinical baseline data was captured, and medical symptom resolution and urine routine examination results were used to measure treatment response. The subjects were followed up over 10 days following their therapy in order to measure relapse. IBM SPSS Statistics version 26 was used to analyze the data, and p < 0.05 was taken as statistically significant. Results: Full symptom remission was observed in 80.0% of children undergoing short-course therapy and 100.0% of children undergoing long-course therapy. Mean post-therapy pus cell count (3.3 ± 2.1/HPF) was also considerably smaller in the long-course arm (3.3 ± 2.1/HPF) compared to the short-course arm (6.4 ± 3.2/HPF; p = 0.004). In the case of follow-up, 26.7% of the short-course group relapsed versus 6.7% of the long-course group and the mean count of pus cells in follow-up was significantly lower in the long-course group (1.7 ± 1.3 vs. 3.8 ± 2.7/HPF; p = 0.011). Conclusion: The results suggest that both treatments regimens were effective in treating pediatric UTI, but the 5-day oral cefixime regimen showed better symptom resolution, more inflammatory urine markers reduction, and a reduced relapse rate compared to the 3-day regimen. It would be advisable to conduct larger prospective studies to validate these findings and provide evidence-based recommendations as to the duration of antibiotic therapy that is most effective in the treatment of children with UTI.