Shorter-course antibiotic therapy is comparable to longer-course for children with acute uncomplicated UTIsShorter Antibiotic Courses May Work for Children with UTIs

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.