The role of bacterial adhesins in the outcome of childhood urinary tract infections.
OBJECTIVE
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.


METHODS
Randomized, double-blind, controlled trial.


METHODS
A pediatric infectious diseases clinic at an urban medical center.


METHODS
Thirty-seven children with uncomplicated urinary tract infections.


METHODS
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.


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.
Johnson
C E
CE
Department of Pediatrics, Case Western Reserve School of Medicine, MetroHealth Medical Center, Cleveland, OH 44109-1998.
Maslow
J N
JN
Fattlar
D C
DC
Adams
K S
KS
Arbeit
R D
RD
D018830:Adhesins, Escherichia coli; D000658:Amoxicillin / Q000627:therapeutic use*; D019980:Amoxicillin-Potassium Clavulanate Combination; D001422:Bacterial Adhesion / Q000235:genetics; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D002675:Child, Preschool; D002969:Clavulanic Acids / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D004926:Escherichia coli / Q000235:genetics; D004927:Escherichia coli Infections / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009876:Operon; D012008:Recurrence; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology*
D018830:Adhesins, Escherichia coli; D001425:Bacterial Outer Membrane Proteins; D002969:Clavulanic Acids; D019980:Amoxicillin-Potassium Clavulanate Combination; D000658:Amoxicillin