The role of bacterial adhesins in the outcome of childhood urinary tract infections
C. E. Johnson, J. N. Maslow, D. C. Fattlar, K. S. Adams and R. D. Arbeit
Department of Pediatrics, Case Western Reserve School of Medicine, MetroHealth Medical Center, Cleveland, OH 44109-1998.
OBJECTIVES--To compare the efficacy of 3-day vs 10-day treatment with a
combination of amoxicillin and clavulanate potassium for children with
uncomplicated urinary tract infections and to determine the role of host
factors, including vesicoureteral reflux, and of bacterial virulence
factors, including adhesins, in treatment outcome. DESIGN--Randomized,
double-blind, controlled trial. SETTING--A pediatric infectious diseases
clinic at an urban medical center. PATIENTS--Thirty-seven children with
uncomplicated urinary tract infections. INTERVENTIONS--Treatment with 3
days or 10 days of antibiotics at a dosage of 20 mg/kg per day of
amoxicillin and 5 mg/kg per day of clavulanate potassium in three divided
doses. MEASUREMENTS AND MAIN RESULTS--The success rate for 10-day treatment
was 82% (14/17) compared with 55% (11/20) for 3-day treatment (P = .09).
Among the 35 patients infected with Escherichia coli, all 10 patients
infected with adhesin-negative isolates were treated successfully
regardless of the duration of treatment, whereas only 14 (56%) of the 25
infections involving adhesin-positive isolates were clinically cured (P =
.015). Two of the three failures in the 10-day treatment group were in
patients with reflux. CONCLUSIONS--We conclude that 3-day treatment with
amoxicillin and clavulanate is insufficient for afebrile childhood urinary
tract infections and that both bacterial and host factors affect treatment
outcome.
