CRITICAL APPRAISAL

1. Did the review address a clearly focused question?

Yes,
Comparing Short- and Long-Course Antibiotic Therapy for Urinary Tract
Infections in Children.
2. Did the authors look for the right type of
papers?
Yes,
Addressed review question with appropriate study design RCT.
3. Do you think all the important, relevant
studies were included?
Yes,
National Library of Medicine’s PubMed search engine to search
Medline for all English-language, published studies.
indexed by the MeSH terms “urinary tract infection” and “antibiotics”
and limited the search to RCTs, children age 0 to 18 years, and humans.
References of all retrieved articles were scanned.
Cochrane Library Web site for systematic reviews on treatment of UTI.
Experts were contacted in the field to identify other published and
unpublished trials.
4. Did the review’s authors do enough to
assess quality of the included studies?
Yes,
Inclusion of 9 scoring system to evaluate the quality.
5. If the results of the review have been
combined, was it reasonable to do so?
Yes,
Even though, None of the studies included in the meta-analysis
satisfied all of the quality criteria but , in the meta-regression neither
study quality nor mean participant age was significantly associated with
the odds ratio of treatment failure or reinfection, in either the complete
set of studies or the subset of studies restricted to patients with lower
UTI.
6. What are the overall results of the review?
Pooled estimate of RR of treatment failure with short course antibiotic therapy was
1.94 (95% CI: 1.19–3.15; Fig 1) and for the RR of reinfection was 0.76 (95%: CI 0.39–
1.47; Fig 2).
Exclusion of 3 studies that did not restrict their participants to patients with lower
UTI, the pooled RR of treatment failure was 1.74 (95% CI: 1.05–2.88) and the pooled
RR of reinfection was 0.69 (95% CI: 0.32–1.52).
11 studies comparing single-dose or 1-day therapy with long-course therapy, the
pooled RR of treatment failure was 2.73 (95% CI: 1.38–5.40) and of reinfection was
0.37 (95% CI: 0.12–1.18).
5 studies comparing 3-day therapy with long-course therapy, the pooled RR of
treatment failure was 1.36 (95% CI: 0.68–2.72) and of reinfection was 0.99 (95% CI:
0.46–2.13).
7. How precise are the results?
Fig1: (95% CI: 1.19–3.15). Depicts more episodes of treatment failure
and since the diamond does not touch the line of no effect the
difference between two groups is statistically significant.
Fig 2: (95% CI: 0.39–1.47). Depicts less episodes of outcome of interest
and no statistical significant difference between the groups.
8. Can the results be applied to the local
population?
Yes,
This meta-analysis provides an empirical basis for the current
widespread and recommended practice of treating pediatric UTIs with
antibiotics for 7 to 14 days. Given the clinically and statistically
significant results.
9. Were all important outcomes considered?
No,
Antibiotic side effects and antibiotic sensitivity/resistance was not
considered.
10. Are the benefits worth the harms and
costs?
Can’t tell.
The meta analysis looked at Randomized, Controlled Trials Comparing
Short- and Long-Course Antibiotic Therapy for Urinary Tract Infections
in Children. No mention was on the costs but as per the review, no
additional comparative trials are warranted.