Short Intravenous Antibiotic Courses for Urinary Infections in Young Infants: A Systematic Review

CONTEXT: Urinary tract infections (UTIs) are common in young infants, yet there is no guidance abstract on the optimal duration of intravenous (IV) treatment.OBJECTIVE: To determine if shorter IV antibiotic courses (<= 7 days) are appropriate for managing UTIs in infants aged < 90 days.METHODS: PubMed, the Cochrane Library, Medline, and Embase (February 2021) were used as data sources. Included studies reported original data for infants aged <= 90 days with UTIs, studied short IV antibiotic durations (< 7 days), and described at least 1 treatment outcome. The Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline was followed. Studies were screened by 2 investigators, and bias was assessed by using the Newcastle-Ottawa Scale and the Revised Cochrane Risk-of-Bias Tool.RESULTS: Eighteen studies with 16 615 young infants were included. The largest 2 studies on bacteremic UTI found no difference in the rates of 30-day recurrence between those treated with <= 7 vs > 7 days of IV antibiotics. For nonbacteremic UTI, there wa <= 3 vs > 3 days of IV antibiotics in the largest 2 studies identified. Three studies of infants aged >= 30 days used oral antibiotics alone and reported good outcomes, although only 85 infants were <= 90 days old.CONCLUSIONS: Shorter IV antibiotic courses of <= 7 days and <= 3 days with early switch to oral antibiotics should be considered in infants aged < 90 days with bacteremic and nonbacteremic UTI, respectively, after excluding meningitis. Further studies of treatment with oral antibiotics alone are needed in this age group.