Table 1.

GRADE evaluation of interventions for UTI in children

Important outcomes	Cure rate (signs of infection), renal parenchymal defects, recurrent infection, renal function, adverse effects
Number of studies (participants)	Outcome	Comparison	Type of evidence	Quality	Consistency	Directness	Effect size	GRADE	Comment
What are the effects of treatment of acute urinary tract infection in children?
At least 7 RCTs (at least 293 children)	Cure rate (signs of infection)	Single-dose or single-day course of oral antibiotics v longer course of oral antibiotics	4	–2	–1	0	0	Very low	Quality points deducted for incomplete reporting of results and weak methods. Consistency point deducted for statistical heterogeneity
3 (312)	Recurrent infection	Single-dose or single-day course of oral antibiotics v longer course of oral antibiotics	4	–2	0	0	0	Low	Quality points deducted for incomplete reporting of results and weak methods
2 (808)	Cure rate (signs of infection)	Oral antibiotics alone v IV plus oral antibiotics	4	–1	0	0	0	Moderate	Quality point deducted for weak methods in the RCTs
1 (287)	Recurrent infection	Oral antibiotics alone v IV plus oral antibiotics	4	0	0	0	0	High
3 (824)	Renal parenchymal defects	Oral antibiotics alone v IV plus oral antibiotics	4	–1	0	0	0	Moderate	Quality point deducted for weak methods in the RCTs
1 (258)	Renal parenchymal defects	Immediate empirical antibiotics v delayed antibiotics	4	0	0	–1	0	Moderate	Directness point deducted as RCT not designed to answer this question
At least 8 RCTs (at least 507 children)	Cure rate (signs of infection)	Shorter course (2–4 days) of oral antibiotics v longer course of oral antibiotics	4	0	0	0	0	High
5 (327)	Recurrent infection	Shorter course (2–4 days) of oral antibiotics v longer course of oral antibiotics	4	0	0	0	0	High
4 (305)	Cure rate (signs of infection)	Shorter course of initial IV antibiotics v longer course of initial IV antibiotics	4	0	0	0	0	High
4 (445)	Recurrent infection	Shorter course of initial IV antibiotics v longer course of initial IV antibiotics	4	0	0	0	0	High
3 (343)	Renal parenchymal defects	Shorter course of initial IV antibiotics v longer course of initial IV antibiotics	4	0	0	0	0	High
5 studies	Renal parenchymal defects	Prolonged delay in starting antibiotics	2	0	0	–1	0	Very low	Directness point deducted for studies not being designed to answer the question
What are the effects of interventions to prevent recurrence of urinary tract infection in children?
1 (60)	Recurrent infection	Immunotherapy v placebo	4	–1	0	0	0	Moderate	Quality point deducted for sparse data
7 (1169)	Recurrent infection	Prophylactic antibiotics v placebo/no treatment	4	0	0	–1	0	Moderate	Directness point deducted for different durations of antibiotic prophylaxis
2 (408)	Renal parenchymal defects	Prophylactic antibiotics v placebo/no treatment	4	0	0	0	0	High
3 (309)	Recurrent infection	Different antibiotics versus each other	4	0	0	0	0	High
At least 4 RCTs (at least 470 children)	Recurrent infection	Surgical correction plus antibiotics v antibiotics alone (children with moderate/severe vesicoureteric reflux)	4	0	0	0	0	High
3 (468)	Renal parenchymal defects	Surgical correction plus antibiotics v antibiotics alone (children with moderate/severe vesicoureteric reflux)	4	0	0	0	0	High
2 (154)	Renal function	Surgical correction plus antibiotics v antibiotics alone (children with moderate/severe vesicoureteric reflux)	4	–1	0	0	0	Moderate	Quality point deducted for sparse data
1 (60)	Recurrent infection	Endoscopic surgical management v prophylactic antibiotics	4	–1	0	0	0	Moderate	Quality point deducted for sparse data

Type of evidence: 4 = RCT; 2 = Observational; 1 = Non-analytical/expert opinion. Consistency: similarity of results across studies. Directness: generalisability of population or outcomes. IV, intravenous