Shorter, oral antibiotics for childhood UTI, and less prophylaxis

The edition in brief

The technical report behind the updated American Academy of Pediatrics urinary tract infection guideline pooled 60 studies. At low to very low certainty, it found that seven days or fewer of antibiotics probably does not increase recurrence and likely means fewer adverse effects; that oral treatment may work as well as starting intravenously; that continuous prophylaxis in reflux or bladder-bowel dysfunction may not reduce breakthrough infection or scarring but may increase resistant infections; and that evaluation within 72 hours of symptoms may mean less scarring. In the second stage of the OUTMATCH trial, 117 children and adults with peanut plus at least two other food allergies were randomised to continued omalizumab or multi-food oral immunotherapy: 36% against 19% tolerated the target dose of all three foods, largely because 22% stopped immunotherapy for adverse effects and 37% needed adrenaline, against 7% on omalizumab. An Australian and New Zealand cohort of 5,119 children with suspected sepsis found steroids given to almost one in ten, mostly outside refractory shock. A NICU quality project cut stays for transient tachypnoea of the newborn from 90 to 51 hours. The pearl covers when a febrile infant needs a urine sample.