Shorter- vs. longer-course antibiotics in children with acute uncomplicated UTIs: a systematic review and meta-analyses.

BACKGROUND

Urinary tract infections (UTIs) are common in children, and longer antibiotic therapy typically lasts 7∼14 days. However, the efficacy and safety of shorter-course regimens remain uncertain.

OBJECTIVES

To compare shorter-course (2∼5 days) vs. longer-course (≥7 days) antibiotic therapy for children with acute uncomplicated UTIs.

METHODS

A systematic review and meta-analysis was conducted.

DATA SOURCES: We searched Cochrane Central Register of Controlled Trials, MEDLINE, and Embase from inception to 3 October 2025.

STUDY ELIGIBLE CRITERIA: Randomized controlled trials.

PARTICIPANTS AND INTERVENTIONS: Children (2 months to 18 years) with acute uncomplicated UTIs received longer-course (≥7 days) or shorter-course (2∼5 days) antibiotic therapy.

ASSESSMENT OF RISK OF BIAS: Two independent reviewers conducted Risk-of-Bias (RoB) assessments for each outcome using the RoB 2.0 tool.

METHODS OF DATA SYNTHESIS: Meta-analyses were performed using random-effects models. For all outcomes, we calculated risk ratio (RR) with 95% CIs. Absolute effects (risk difference [RD]) were calculated using RR and baseline risks, and the certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.

RESULTS

Thirteen trials (15 data sets) involving 2010 children were included. High- or moderate-certainty evidence showed that shorter-course antibiotic therapy probably results in no difference in relapse rate (RR 1.08, 95% CIs 0.79-1.47; RD 8 more per 1000, 95% CIs 21 fewer to 47 more) and reinfection rate (RR 0.63, 95% CIs 0.38-1.03; RD 93 fewer per 1000, 95% CIs 156 fewer to 8 more), compared with longer-course. Low certainty evidence showed that, compared with longer-course antibiotic therapy, shorter-course antibiotic therapy may result in little or no difference in bacteriological cure rate (RR 0.96, 95% CIs 0.90-1.03; RD 36 fewer per 1000, 95% CIs 91 fewer to 27 more) and clinical cure rate (RR 0.99, 95% CIs 0.90-1.10; RD 10 fewer per 1000, 95% CIs 96 fewer to 96 more). Shorter-course antibiotic therapy probably (moderate-certainty) results in no difference in all adverse events, compared with longer-course (RR 0.93, 95% CIs 0.83-1.04; RD 5 fewer per 1000, 95% CIs 13 fewer to 3 more).

CONCLUSIONS

For children with acute uncomplicated UTIs, a shorter-course antibiotic therapy appears comparable with the longer-course in terms of efficacy and safety. Further research is needed to define the optimal treatment duration for specific subgroups, particularly for population such as infants (2 months to 2 years) and children with recurrent UTIs or fever.