7-day Compared With 10-day Antibiotic Treatment for Febrile Urinary Tract Infections in Children

NCT ID: NCT03221504

Last Updated: 2018-03-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

221 participants

Study Classification

INTERVENTIONAL

Study Start Date

2018-01-01

Study Completion Date

2020-01-31

Brief Summary

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The investigators aim to assess the effectiveness of a 7-day compared with a 10-day course of antibiotic treatment for febrile urinary tract infections (UTIs) in children. It is formulated a hypothesis that a 7-day course of antibiotic therapy is equally effective as a 10-day course of therapy and would entail a lower risk of adverse events and better compliance.

Detailed Description

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In previously published European and global guidelines, there has been no consensus among experts regarding the duration of therapy for a febrile UTI. Depending on the recommendation, the duration of treatment should be between 7-14 days.

221 patients aged 3 months to 7 years with febrile UTIs (defined as a combination of fever and leukocyturia in urine sediment) will be randomly assigned to receive a 7-day treatment arm (7 days of cefuroxime/cefuroxime axetil followed by 3 days of blinded placebo) or a 10-day treatment arm (7 days of cefuroxime/cefuroxime axetil followed by 3 days of blinded cefuroxime axetil).

The primary outcome measure will be frequencies of recurrence and reinfection of UTI during the 6 months after the intervention. The secondary outcome measures will be antibiotic-associated diarrhea and compliance.

Conditions

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Urinary Tract Infections in Children

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

TRIPLE

Participants Caregivers Investigators

Study Groups

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Antibiotic therapy for 10 days

After 7 days of cefuroxime treatment (oral, intravenous or sequential), patients from day 8 to day 10 will continue to receive the antibiotic (in blinded bottle).

Group Type ACTIVE_COMPARATOR

Longer therapy duration

Intervention Type OTHER

Patients will receive cefuroxime axetil orally. Treatment will involve the supply of cefuroxime axetil 30 mg/kg/d in two divided doses (in blinded bottles).

Antibiotic therapy for 7 days

After 7 days of cefuroxime therapy (oral, intravenous or sequential), children from day 8 to day 10 will receive placebo (in blinded bottle).

Group Type EXPERIMENTAL

Shorter therapy duration

Intervention Type OTHER

Patients will receive placebo orally (in blinded bottles). The volume of the placebo will be like cefuroxime syrup.

Interventions

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Longer therapy duration

Patients will receive cefuroxime axetil orally. Treatment will involve the supply of cefuroxime axetil 30 mg/kg/d in two divided doses (in blinded bottles).

Intervention Type OTHER

Shorter therapy duration

Patients will receive placebo orally (in blinded bottles). The volume of the placebo will be like cefuroxime syrup.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* children aged from 3 months to 7 years
* clinical diagnosis of a febrile UTI at presentation according to urinalysis (white blood cells in the sediment \>10 in the field of view);
* fever ≥38°C
* positive urine collection with sensitivity for cefuroxime
* treatment cefuroxime or cefuroxime axetil for 7 days

Exclusion Criteria

* history of a UTI in the last 3 months
* prophylaxis for UTI
* antibiotic therapy in the last month
* known allergy to the study drugs
* immunosuppression therapy
* disease with immune deficiency
* children with other coexisting infection, e.g. meningitis, sepsis, pneumonia, otitis
* severe obstructive uropathy
Minimum Eligible Age

3 Months

Maximum Eligible Age

7 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Medical University of Warsaw

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Malgorzata Pańczyk-Tomaszewska, Assistant Professor

Role: STUDY_CHAIR

Medical Univeristy of Warsaw

Maria Daniel, MD

Role: PRINCIPAL_INVESTIGATOR

Medical Univeristy of Warsaw

Locations

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Children's Hospital for The Medical University of Warsaw

Warsaw, , Poland

Site Status RECRUITING

The Holy Family Specialistic Hospital

Warsaw, , Poland

Site Status RECRUITING

Countries

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Poland

Central Contacts

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Maria Daniel, MD

Role: CONTACT

+48696477117

Facility Contacts

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Maria Daniel, MD

Role: primary

696477117 ext. 0048

Maria Daniel, MD

Role: primary

References

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Simoes e Silva AC, Oliveira EA. Update on the approach of urinary tract infection in childhood. J Pediatr (Rio J). 2015 Nov-Dec;91(6 Suppl 1):S2-10. doi: 10.1016/j.jped.2015.05.003. Epub 2015 Sep 7.

Reference Type BACKGROUND
PMID: 26361319 (View on PubMed)

Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA. 2007 Jul 11;298(2):179-86. doi: 10.1001/jama.298.2.179.

Reference Type BACKGROUND
PMID: 17622599 (View on PubMed)

Craig JC, Simpson JM, Williams GJ, Lowe A, Reynolds GJ, McTaggart SJ, Hodson EM, Carapetis JR, Cranswick NE, Smith G, Irwig LM, Caldwell PH, Hamilton S, Roy LP; Prevention of Recurrent Urinary Tract Infection in Children with Vesicoureteric Reflux and Normal Renal Tracts (PRIVENT) Investigators. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med. 2009 Oct 29;361(18):1748-59. doi: 10.1056/NEJMoa0902295.

Reference Type BACKGROUND
PMID: 19864673 (View on PubMed)

Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management; Roberts KB. Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics. 2011 Sep;128(3):595-610. doi: 10.1542/peds.2011-1330. Epub 2011 Aug 28.

Reference Type BACKGROUND
PMID: 21873693 (View on PubMed)

Montini G, Toffolo A, Zucchetta P, Dall'Amico R, Gobber D, Calderan A, Maschio F, Pavanello L, Molinari PP, Scorrano D, Zanchetta S, Cassar W, Brisotto P, Corsini A, Sartori S, Da Dalt L, Murer L, Zacchello G. Antibiotic treatment for pyelonephritis in children: multicentre randomised controlled non-inferiority trial. BMJ. 2007 Aug 25;335(7616):386. doi: 10.1136/bmj.39244.692442.55. Epub 2007 Jul 4.

Reference Type BACKGROUND
PMID: 17611232 (View on PubMed)

Michael M, Hodson EM, Craig JC, Martin S, Moyer VA. Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children. Cochrane Database Syst Rev. 2003;(1):CD003966. doi: 10.1002/14651858.CD003966.

Reference Type BACKGROUND
PMID: 12535494 (View on PubMed)

Ammenti A, Cataldi L, Chimenz R, Fanos V, La Manna A, Marra G, Materassi M, Pecile P, Pennesi M, Pisanello L, Sica F, Toffolo A, Montini G; Italian Society of Pediatric Nephrology. Febrile urinary tract infections in young children: recommendations for the diagnosis, treatment and follow-up. Acta Paediatr. 2012 May;101(5):451-7. doi: 10.1111/j.1651-2227.2011.02549.x. Epub 2012 Jan 3.

Reference Type BACKGROUND
PMID: 22122295 (View on PubMed)

Daniel M, Szajewska H, Panczyk-Tomaszewska M. 7-day compared with 10-day antibiotic treatment for febrile urinary tract infections in children: protocol of a randomised controlled trial. BMJ Open. 2018 Mar 2;8(3):e019479. doi: 10.1136/bmjopen-2017-019479.

Reference Type DERIVED
PMID: 29500209 (View on PubMed)

Related Links

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https://www.nice.org.uk/guidance/qs36

National Institute for Health and Care Excellence. Urinary tract infections in children and young people 2013 July

http://uroweb.org/guideline/paediatric-urology/#3

European Association of Urology; European Society for Pediatric Urology Urinary tract infections in children: EAU/ESPU guidelines.

http://www.cps.ca/en/documents/position/urinary-tract-infections-in-children

Canadian Paediatric Society, Urinary tract infection in infants and children: Diagnosis and management

Other Identifiers

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WUM

Identifier Type: -

Identifier Source: org_study_id

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