Short-Course Therapy for Urinary Tract Infections in Children: The SCOUT Randomized Clinical Trial

JAMA Pediatr. 2023 Aug 1;177(8):782-789. doi: 10.1001/jamapediatrics.2023.1979.


Importance: There is a paucity of pediatric-specific comparative data to guide duration of therapy recommendations in children with urinary tract infection (UTI).

Objective: To compare the efficacy of standard-course and short-course therapy for children with UTI.

Design, setting, participants: The Short Course Therapy for Urinary Tract Infections (SCOUT) randomized clinical noninferiority trial took place at outpatient clinics and emergency departments at 2 children's hospitals from May 2012, through, August 2019. Data were analyzed from January 2020, through, February 2023. Participants included children aged 2 months to 10 years with UTI exhibiting clinical improvement after 5 days of antimicrobials.

Intervention: Another 5 days of antimicrobials (standard-course therapy) or 5 days of placebo (short-course therapy).

Main outcome measures: The primary outcome, treatment failure, was defined as symptomatic UTI at or before the first follow-up visit (day 11 to 14). Secondary outcomes included UTI after the first follow-up visit, asymptomatic bacteriuria, positive urine culture, and gastrointestinal colonization with resistant organisms.

Results: Analysis for the primary outcome included 664 randomized children (639 female [96%]; median age, 4 years). Among children evaluable for the primary outcome, 2 of 328 assigned to standard-course (0.6%) and 14 of 336 assigned to short-course (4.2%) had a treatment failure (absolute difference of 3.6% with upper bound 95% CI of 5.5.%). Children receiving short-course therapy were more likely to have asymptomatic bacteriuria or a positive urine culture at or by the first follow-up visit. There were no differences between groups in rates of UTI after the first follow-up visit, incidence of adverse events, or incidence of gastrointestinal colonization with resistant organisms.

Conclusions and relevance: In this randomized clinical trial, children assigned to standard-course therapy had lower rates of treatment failure than children assigned to short-course therapy. However, the low failure rate of short-course therapy suggests that it could be considered as a reasonable option for children exhibiting clinical improvement after 5 days of antimicrobial treatment.

Trial registration: Identifier: NCT01595529.

Publication types

  • Research Support, N.I.H., Extramural
  • Comment

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Bacteriuria* / drug therapy
  • Child
  • Child, Preschool
  • Duration of Therapy
  • Female
  • Humans
  • Treatment Outcome
  • Urinary Tract Infections* / drug therapy


  • Anti-Bacterial Agents

Associated data