There are times when parenteral antibiotics seem more effective than oral antibiotics due to concerns about absorption and adherence to therapy, especially for young infants with developing immune systems. One such instance that calls for parenteral antibiotics is for the febrile infant with a urinary tract infection (UTI), who could develop bacteremia. No one would argue with the need to institute parenteral antibiotics in such patients, but for how long should we treat, especially if the bacterial organism is sensitive to an oral antibiotic. Does shorter parenteral treatment mean a significant risk of recurrence of UTI or readmission?
Desai et al. (10.1542/peds.2018-3844) opted to study that question in a study we are early releasing this week by sharing the results of a multicenter retrospective cohort of infants less than 60 days old who had positive blood and urine cultures at 11 children’s hospitals between 2011 to 2016. The authors compared parenteral antibiotic treatment less than 7 days with parenteral treatment over 7 days and then collected outcome data on UTI recurrence and readmissions over the next 30 days. There were no differences in recurrence or readmission when comparing those who got a shorter course of parenteral antibiotics and then were switched over to oral antibiotics for the duration of their course with those who got a longer course of parenteral antimicrobials.
So how convincing is this data? Would it make you shorten your parenteral course to less than 7 days for a bacteremic infant with a UTI? To help make sense of this study we asked Drs. Natalia Leva and Hillary Copp, two urologists at UCSF, to add their perspective in an accompanying commentary (10.1542/peds.2019-1611). The authors emphasize the excellence of the methods used to extract the data in this study for validity and reliability and provide some discussion why duration of parenteral antibiotics may not make a difference although total duration of antibiotic therapy both parenteral and oral might (but has not yet been studied). Take a peek at both this important study and commentary and see if it changes your duration of parenteral therapy going forward. If so, please let us know by responding to this blog, posting a comment on our Facebook or Twitter pages.