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LETTER
Short versus standard duration antibiotic treatment for UTIs: a comparison of two meta-analyses
  1. R Keren1,
  2. E Chan2
  1. 1Department of Pediatrics, The Children’s Hospital of Philadelphia, USA
  2. 2Department of Pediatrics, The Children’s Hospital of Boston, USA
  1. Correspondence to
    R Keren;
    keren{at}email.chop.edu

https://doi.org/10.1136/adc.88.1.89-a

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    Having recently published a meta-analysis on the same clinical question,1 it was with great interest that we read Michael et al’s systematic review of short versus standard duration antibiotics for urinary tract infections (UTIs) in children.2 Given the publication (in close succession) of two meta-analyses on the same question with (on the surface) strikingly different results, we thought a comment was in order.

    First, we applaud the authors on their methodologically sound review. The literature search was explicitly described and exhaustive. In fact, the authors identified a few studies that we had missed.3–,6 The study outcomes for meta-analysis (frequency of positive urine cultures at 0–7 days after treatment and at 10 days to 15 months after treatment, and development of resistant organisms and recurrent UTI) were relevant and clearly defined.

    The authors provided appropriate and important meta-analysis measures including summary relative risks (RRs) and a quasi-NNT calculation with varying risk of treatment failure in the standard treatment group and confidence intervals corresponding to “best” and “worst” case scenarios.

    For their primary outcome, frequency of positive urine cultures 0–7 days after treatment, the authors found no significant difference between short (2–4 days) and standard (7–14 days) treatment (RR 1.06; 95% CI 0.64 to 1.76). This is in contrast to our finding of a 94 % increased pooled risk of treatment failure with short course treatment (≤3 days) compared to standard treatment (7–14 days) (RR 1.94, 95% CI 1.19 to 3.15; NNT=13, 95% CI 100 to 7). Why the discrepancy? We postulate a few possible explanations and conclude that the two meta-analyses, on closer inspection, actually have very similar results.

    Our omission of certain studies identified by Michael and colleagues may have biased our results. However, of the three …

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