| Urinary tract infection
Two systematic reviews have assessed the effect of antibiotics for treating uncomplicated lower urinary tract infection in children [13,14]. The more recent included 16 RCTs in 1,116 children from 2 weeks to 18 years age [13]. The review found a long course (10-day) antibiotic treatment is more likely to eliminate bacteria from the urine than single-dose treatments, but there was no difference in rates of persistent bacteriuria, recurrence or reinfection. A single RCT in 48 children 1 to 13 years of 3 versus 10 days oral amoxicillin-clavulanate (20 + 5 mg/kg/d in 3 doses) reported no difference in bacteriuria at end of treatment (short 9/20 versus long 3/17; RR 2.55, 95% CI 0.82, 7.94) or UTI 1 to 15 months after treatment (2/20 versus 2/17; RR 0.85, 95% CI 0.13, 5.41). A single RCT in infants <4 months age comparing amoxicillin-clavulanate (dose not reported) in 7 infants to 4 other antibiotics for non-severe UTI that reported no difference in rate of resolution of bacteriuria. [15] Another systematic review assessed the effect of antibiotics for treating acute pyelonephritis in children. The review included 27 RCTs in 4452 children >1 month of age and was biased towards children who were less sick. [16] Oral antibiotics for 10 to 14 days were as effective as sequential IV therapy for 3 days followed by oral therapy for a total duration of 10 to 14 days, suggesting that children with acute pyelonephritis can be treated effectively with oral antibiotics. If IV antibiotic therapy is given, a short course of IV therapy given for two to four days followed by oral therapy with total therapy duration of 10 to 21 days was as effective as a longer duration of IV antibiotic therapy given for seven to 10 days with total duration of therapy of 10 to 21 days. [16] [LOE I GOR B for infants >1 month age] Four trials including 523 infants included IV or oral amoxicillin-clavulanate as a comparator to other antibiotics with no significant differences in outcomes reported in any. The dose of intravenous amoxicillin-clavulanate was 25mg/kg/dose 6 hourly, and oral amoxicillin-clavulanate ranged from 50 mg/kg/day to 50 mg/kg/dose 8 hourly.
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