Paediatric UTI reviews point to shorter, oral antibiotic courses; renal ultrasound misses much vesicoureteral reflux

The edition in brief

A technical review of 60 studies underpinning the updated American Academy of Pediatrics guideline on paediatric urinary tract infection found low to very low certainty overall, but suggested courses of 7 days or fewer may not raise recurrent infection while reducing adverse events, oral therapy may be as effective as parenteral therapy while avoiding hospital harms, continuous antibiotic prophylaxis may not reduce breakthrough infection or renal scarring but may raise resistant infection, and evaluation within 72 hours of symptom onset may be associated with less scarring. A companion review of 90 studies found renal and bladder ultrasound has poor accuracy for vesicoureteral reflux after a first UTI (pooled sensitivity 50%, specificity 71%) and after recurrent UTI (sensitivity 26%, specificity 79%). In 62 randomised trials of metastatic renal cell carcinoma (24,518 patients), trial-level correlation of progression-free survival with overall survival was moderate (r = 0.52) and the analysis did not support reliable surrogacy. A mouse study of human antibodies against PAPPA, a protease that frees IGF1, reported less cyst growth, inflammation and fibrosis in polycystic kidney disease models, with weaker protection in females; no human data exist yet.