Oral Antibiotics Alone in Children Aged 4 Weeks to 2 Months With a Urinary Tract Infection

NCT ID: NCT05819229

Last Updated: 2024-07-08

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

RECRUITING

Total Enrollment

125 participants

Study Classification

OBSERVATIONAL

Study Start Date

2023-02-27

Study Completion Date

2025-05-01

Brief Summary

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The goal of this prospective study is to investigate whether oral antibiotic therapy alone is feasible and safe in clinically stable children aged 4 weeks to 2 months without any past high-risk medical history with a suspected or confirmed urinary tract infection.

Detailed Description

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All children aged 4 weeks to 2 months with a suspected urinary tract infection will be observed and examined by physicians and nurses as recommended by current guidelines. Children needing empirical antibiotic therapy will be admitted. The remaining will be contacted by phone if the urine culture is positive, and antibiotic therapy will be initiated if a urinary tract infection is still suspected due to persistent symptoms.

Clinically stable (see eligibility criteria) children without any past high-risk medical history (see eligibility criteria) will initiate oral antibiotic therapy. As empirical oral therapy, amoxicillin-clavulanic acid 50 mg/kg/day divided into 3 doses will be used. If the sensitivity pattern is available, a smaller-spectrum antibiotic can be used instead. If these children at any time point become clinically unstable or have a positive blood culture without suspected contamination, parenteral antibiotic therapy will be initiated. As empirical parenteral therapy, gentamicin 5 mg/kg once daily and ampicillin 100 mg/kg/day divided into 3 doses will be used. If the sensitivity pattern is available, another parenteral antibiotic regime can be used instead.

Admitted children can be sent home when they have clinically improved (judged by the physician) and have been hospitalized at least until the ward round the following day. Parents will be informed to contact the pediatric emergency department immediately if the child worsens or does not tolerate the antibiotics.

A physical or virtual follow-up will be conducted on day 3 (approximately 72 hours after treatment initiation) to ensure clinical improvement and treatment adherence. If needed, antibiotic therapy will be changed according to the sensitivity pattern. Children with a negative urine culture will be informed to stop antibiotic therapy.

The duration of antibiotic therapy will be 10 days. All children will undergo a renal ultrasound within the treatment period.

The above recommendations has been implemented as routine care. Hence, no parental consent is needed.

Conditions

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Urinary Tract Infections in Children

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Oral antibiotic therapy

Clinically stable (see eligibility criteria) children without any past high-risk medical history (see eligibility criteria) will initiate oral antibiotic therapy.

Oral antibiotic therapy

Intervention Type DRUG

Empirical choice: amoxicillin-clavulanic acid 50 mg/kg/day divided into three doses.

If the sensitivity pattern is available, another oral antibiotic, preferably smaller-spectrum, can be used instead.

Total duration of antibiotic therapy will be 10 days.

Interventions

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Oral antibiotic therapy

Empirical choice: amoxicillin-clavulanic acid 50 mg/kg/day divided into three doses.

If the sensitivity pattern is available, another oral antibiotic, preferably smaller-spectrum, can be used instead.

Total duration of antibiotic therapy will be 10 days.

Intervention Type DRUG

Eligibility Criteria

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Inclusion Criteria

1. Clinical suspicion of urinary tract infection irrespective of the presence of fever.
2. Clinically stable (i.e., not respiratory or circulatory affected, septic, or meningeal).
3. 4 weeks to 2 months of age (corrected age, if premature).

All children who do not receive any empirical antibiotic therapy but have a positive urine culture can be included if the clinical suspicion of urinary tract infection persists.

A positive urine culture is defined as:

* Suprapubic bladder aspiration: any growth of bacteria.
* Sterile intermittent catheterization: monoculture with ≥10\^3 colony forming units per milliliter (cfu/ml).
* Midstream urine x 2: monoculture with the same bacteria in both tests with ≥10\^4 cfu/ml.
* Midstream urine x 2: monoculture with the same bacteria in both tests with ≥10\^5 cfu/ml in one test and 10\^3 cfu/ml in another test.

Exclusion Criteria

1. Non-Danish civil registration number.
2. High-risk medical history.

1. Previous urinary tract infection.
2. Prophylactic antibiotic treatment.
3. Known urogenital abnormality (i.e., hydronephrosis (pyelectasis ≥10 mm or/and caliectasis ≥5 mm); hydroureter; vesicoureteral reflux; multicystic dysplasia; renal dysplasia; renal hypoplasia; renal agenesis; duplex kidney; ectopic placed kidneys; polycystic kidney disease; neurogenic bladder dysfunction; and hypospadias).
4. Previous hospitalization needing antibiotic therapy.
3. Markedly elevated c-reactive protein indicating bacteremia.
4. Elevated creatinine.
5. Oral therapy is not possible (e.g., frequent vomiting or excessive regurgitation).
Minimum Eligible Age

4 Weeks

Maximum Eligible Age

2 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hvidovre University Hospital

OTHER

Sponsor Role collaborator

Rigshospitalet, Denmark

OTHER

Sponsor Role lead

Responsible Party

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Ulrikka Nygaard

Principal investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Naqash Sethi, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark

Ulrikka Nygaard, Ass. prof, Ph.D.

Role: STUDY_CHAIR

Department of Pediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark

Locations

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Copenhagen University Hospital Rigshospitalet

Copenhagen, , Denmark

Site Status RECRUITING

Copenhagen University Hospital Herlev

Herlev, , Denmark

Site Status RECRUITING

Copenhagen University Hospital Hillerød

Hillerød, , Denmark

Site Status RECRUITING

Copenhagen University Hospital Hvidovre

Hvidovre, , Denmark

Site Status RECRUITING

Countries

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Denmark

Central Contacts

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Naqash Sethi, MD

Role: CONTACT

+4528405083

Ulrikka Nygaard, Ass. prof, Ph.D.

Role: CONTACT

+4535459761

Facility Contacts

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Line Sehested, MD

Role: primary

Mette Christensen, MD

Role: primary

+4538685379

Claudia Kai, Ph.D.

Role: primary

+4548296836

Dina Cortes, Prof., DSMc

Role: primary

+4538626602

Other Identifiers

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PO AB UTI

Identifier Type: -

Identifier Source: org_study_id

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