Shorter Antibiotic Courses May Be Effective for Children with Uncomplicated UTIs: Study

The researchers conducted a systematic review and meta-analysis of all literature pertaining to this issue until October 3, 2025, for evaluating the equivalent treatment effects and safety of antibiotic therapy at reduced duration. This systematic review aimed to gather randomized controlled trials involving patients of both genders between 2 months and 18 years of age with acute uncomplicated UTIs and assigned to either a shortened course of antibiotics (2-5 days) or a standard course of antibiotics (7 days or longer).

The risks of bias were assessed independently by two reviewers for each clinical endpoint using the Cochrane Risk of Bias (RoB 2.0) instrument. For the analysis of the data, random-effects models were utilized to generate risk ratios (RR) and absolute risk differences (RD) with corresponding 95% confidence intervals (CI) for each endpoint, with GRADE methodology used for assessment of the overall quality of evidence.

Key findings:

• Data from 13 randomized controlled trials generating 15 different sets of data were synthesized, and these comprised a total of 2,010 pediatric patients.
• The use of shorter courses did not have any influence on the incidence of relapses (RR 1.08, 95% CI 0.79 to 1.47; RD 8 more per 1,000) or the incidence of reinfections (RR 0.63, 95% CI 0.38 to 1.03; RD 93 fewer per 1,000), compared with those who received longer courses.
• There was little to no difference in terms of the bacteriological cure rate (RR 0.96, 95% CI 0.90 to 1.03; RD 36 fewer per 1,000) or the symptomatic response to the infection (RR 0.99, 95% CI 0.90 to 1.10; RD 10 fewer per 1,000).
• Shorter courses were associated with no greater risk of experiencing adverse events related to the administration of the treatment, such as gastrointestinal symptoms (RR 0.93, 95% CI 0.83 to 1.04; RD 5 fewer per 1,000).

To summarize, the present systematic review and meta-analysis provide substantial evidence that shorter-duration courses of antibiotic treatments in children suffering from acute uncomplicated UTIs are not inferior to longer-duration courses in regard to both effectiveness and safety. This conclusive evidence can become an important foundation to introduce the use of shorter-duration courses of antibiotics into the official protocols for the treatment of pediatric acute uncomplicated UTIs in different countries. Nevertheless, more targeted clinical studies are necessary to identify the optimal duration of antibiotic treatment in high-risk subgroups of patients.

Reference:

Liu, M., Wang, Q., Yan, P., Li, Z., Cai, Y., Xu, Z., Belal, A. A., Yao, L., Tian, J., & Gao, Y. (2026). Shorter- versus longer-course antibiotics in children with acute uncomplicated UTIs: a systematic review and meta-analyses. Clinical Microbiology and Infection: The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases. https://doi.org/10.1016/j.cmi.2026.04.022