Summary of findings for the main comparison. Antibiotic treatment versus placebo or no treatment.
| Antibiotic treatment versus placebo or no treatment | ||||||
| Patient or population: children with previous UTI and most do not have a renal tract abnormality such as VUR Setting: children in the community presenting to a hospital who have experienced at least one UTI Intervention: antibiotic treatment Comparison: placebo/no treatment | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Risk with placebo/no treatment | Risk with antibiotic treatment | |||||
| Recurrence of symptomatic UTI in children | 212 per 1,000 | 159 per 1,000 (59 to 420) | RR 0.75 (0.28 to 1.98) | 1074 (5) | ⊕⊕⊝⊝ LOW 1 2 3 | All studies comparing antibiotic treatment with placebo or no treatment. |
| Recurrence of symptomatic UTI in children without VUR | 223 per 1,000 | 134 per 1,000 (29 to 611) | RR 0.60 (0.13 to 2.74) | 541 (4) | ⊕⊕⊝⊝ LOW 2 3 | ‐ |
| Recurrence of symptomatic UTI in children with VUR | 180 per 1,000 | 117 per 1,000 (70 to 192) | RR 0.65 (0.39 to 1.07) | 371 (2) | ⊕⊕⊝⊝ LOW 2 3 | Small sample size because only two studies reported separated data and majority of children did not have VUR |
| Recurrence of symptomatic UTI in children, in studies with adequate allocation concealment | 161 per 1,000 | 110 per 1,000 (77 to 153) | RR 0.68 (0.48 to 0.95) | 914 (2) | ⊕⊕⊕⊝4 MODERATE | ‐ |
| Repeat positive urine culture | 386 per 1,000 | 120 per 1,000 (31 to 455) | RR 0.31 (0.08 to 1.18) | 467 (4) | ⊕⊝⊝⊝ VERY LOW 5 | ‐ |
| All adverse events | 24 per 1,000 | 56 per 1,000 (1 to 1,000) | RR 2.31 (0.03 to 170.67) | 914 (2) | ⊕⊕⊝⊝ LOW 6 | ‐ |
| Microbial resistance to prophylactic drug | 164 per 1,000 | 394 per 1,000 (102 to 1,000) | RR 2.40 (0.62 to 9.26) | 118 (2) | ⊕⊕⊕⊝ MODERATE 7 | ‐ |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; UTI: urinary tract infection; VUR: vesicoureteric reflux | ||||||
| GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 Two studies were consistent with each other but three others were quite variable in their findings
2 Several studies were small and results variable, making the confidence intervals wide
3 Smaller and older studies were quite variable in their findings, did not use blinding and patient selection was unclear
4One study was open label suggesting interpretation bias
5 Studies which did not include symptoms in the diagnosis of UTI are likely to involve misclassification of UTI and asymptomatic bacteriuria
6 One study was open label and all adverse events were in the active arm, suggesting interpretation bias
7 One study conducted screening cultures and therefore examined more samples that may have been from asymptomatic bacteriuria while also demonstrating the presence of a drug resistant organism