***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Abstract Urinary tract infections ( UTI ) can cause acute morbidity and may result in severe problems , including hypertension and reduced renal function . Diagnosis of UTI is extremely important since prompt treatment may prevent damage . In the present study we compared the efficacy of oral cefixime to initial intramuscular ceftizoxime followed by cefixime for the treatment of UTI in children . Fifty-four children were studied . They were r and omized to receive either oral cefixime 8 mg/kg/day for 10 days or initial intramuscular ceftizoxime ( Cefızox ) 50 mg/kg twice a day for 2 days followed by oral cefixime for 8 days . Treatment groups were comparable regarding age , sex , clinical , and laboratory findings . Escherichia coli was isolated from 80 % of patients . Repeat urine cultures were sterile within 24 hours in all children . Cure rates were comparable in both groups ( 92 % vs 86 % at the end of treatment ) . No serious adverse effects were observed . We concluded that oral cefixime is a safe and effective alternative treatment OBJECTIVES 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 . DESIGN R and omized , double-blind , controlled trial . SETTING A pediatric infectious diseases clinic at an urban medical center . PATIENTS Thirty-seven children with uncomplicated urinary tract infections . INTERVENTIONS 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 . MEASUREMENTS AND MAIN 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 clinical ly 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 Background . The st and ard recommendation for treatment of young , febrile children with urinary tract infection has been hospitalization for intravenous antimicrobials . The availability of potent , oral , third-generation cephalosporins as well as interest in cost containment and avoidance of nosocomial risks prompted evaluation of the safety and efficacy of outpatient therapy . Methods . In a multicenter , r and omized clinical trial , we evaluated the efficacy of oral versus initial intravenous therapy in 306 children 1 to 24 months old with fever and urinary tract infection , in terms of short-term clinical outcomes ( sterilization of the urine and defervescence ) and long-term morbidity ( incidence of reinfection and incidence and extent of renal scarring documented at 6 months by99mTc-dimercaptosuccinic acid renal scans ) . Children received either oral cefixime for 14 days ( double dose on day 1 ) or initial intravenous cefotaxime for 3 days followed by oral cefixime for 11 days . Results . Treatment groups were comparable regarding demographic , clinical , and laboratory characteristics . Bacteremia was present in 3.4 % of children treated orally and 5.3 % of children treated intravenously . Of the short-term outcomes , 1 ) repeat urine cultures were sterile within 24 hours in all children , and 2 ) mean time to defervescence was 25 and 24 hours for children treated orally and intravenously , respectively . Of the long-term outcomes , 1 ) symptomatic reinfections occurred in 4.6 % of children treated orally and 7.2 % of children treated intravenously , 2 ) renal scarring at 6 months was noted in 9.8 % children treated orally versus 7.2 % of children treated intravenously , and 3 ) mean extent of scarring was ∼8 % in both treatment groups . Mean costs were at least twofold higher for children treated intravenously ( $ 3577 vs $ 1473 ) compared with those treated orally . Conclusions . Oral cefixime can be recommended as a safe and effective treatment for children with fever and urinary tract infection . Use of cefixime will result in substantial reductions of health care expenditures Objective To compare the efficacy of oral antibiotic treatment alone with treatment started parenterally and completed orally in children with a first episode of acute pyelonephritis . Design Multicentre , r and omised controlled , open labelled , parallel group , non-inferiority trial . Setting 28 paediatric units in north east Italy . Participants 502 children aged 1 month to < 7 years with clinical pyelonephritis . Intervention Oral co-amoxiclav ( 50 mg/kg/day in three doses for 10 days ) or parenteral ceftriaxone ( 50 mg/kg/day in a single parenteral dose ) for three days , followed by oral co-amoxiclav ( 50 mg/kg/day in three divided doses for seven days ) . Main outcomes measures Primary outcome was the rate of renal scarring . Secondary measures of efficacy were time to defervescence ( < 37 � C ) , reduction in inflammatory indices , and percentage with sterile urine after 72 hours . An exploratory subgroup analysis was conducted in the children in whom pyelonephritis was confirmed by dimercaptosuccinic acid ( DMSA ) scintigraphy within 10 days after study entry . Results Intention to treat analysis showed no significant differences between oral ( n=244 ) and parenteral ( n=258 ) treatment , both in the primary outcome ( scarring scintigraphy at 12 months 27/197 ( 13.7 % ) v 36/203 ( 17.7 % ) , difference in risk −4 % , 95 % confidence interval −11.1 % to 3.1 % ) and secondary outcomes ( time to defervescence 36.9 hours ( SD 19.7 ) v 34.3 hours ( SD 20 ) , mean difference 2.6 ( −0.9 to 6.0 ) ; white cell count 9.8 � 109/l ( SD 3.5 ) v 9.5 � 109/l ( SD 3.1 ) , mean difference 0.3 ( −0.3 to 0.9 ) ; percentage with sterile urine 185/186 v 203/204 , risk difference −0.05 % ( −1.5 % to 1.4 % ) ) . Similar results were found in the subgroup of 278 children with confirmed acute pyelonephritis on scintigraphy at study entry . Conclusions Treatment with oral antibiotics is as effective as parenteral then oral treatment in the management of the first episode of clinical pyelonephritis in children . Trial registration Clinical Trials NCT00161330 Urinary tract infection in children is usually treated with orally administered antibiotics for 10 to 14 days . Because of the unreliability of patient compliance with prescribed medications and because single-dose aminoglycoside therapy has been shown to be effective in women with cystitis , we assessed the efficacy of single-dose amikacin for treatment of first episodes of Escherichia coli lower urinary tract infection in girls . Upper and lower urinary tract infections were presumptively differentiated by simple criteria such as clinical symptoms , fever , and erythrocyte sedimentation rate . Fifty-four girls ( ages 1 to 12 years ) with two positive urine cultures ( greater than 10(5 ) CFU/ml E. coli ) were assigned by a table of r and om numbers to receive treatment with either sulfisoxazole 150 mg/kg/day orally for 10 days or a single dose of amikacin 7.5 mg/kg intramuscularly . Six of 23 patients ( 26 % ) in the amikacin group and four of 21 ( 19 % ) in the sulfisoxazole group had at least one positive urine culture within 40 days after completion of therapy . This difference was not statistically significant ( P greater than 0.5 ) . This suggests that a single dose of amikacin is as effective as a 10-day course of sulfisoxazole in the treatment of presumed first lower urinary tract infection in girls . Additional potential advantages of single-dose therapy are fewer side effects and less toxicity , excellent compliance , and reduced potential for selecting resistant organisms 31 patients with a urinary infection were treated with a single oral dose ( 3 g for adults and 100 mg/kg for children ) of amoxycillin ; 23 ( 74 % ) were cured . 20 women and 26 children were then r and omly allocated to either a single dose of amoxycillin of a 5- to 7-day conventional course of the same antibiotic . The results of both treatment regimens were comparable . Single-dose therapy for the treatment of urinary-tract infections was simple , effective and well tolerated . Patients preferred taking their treatment in this manner . Failure of single-dose therapy to eradicate bacteriuria may indicate which patients require subsequent investigations of their urinary tract Objective . To undertake population pharmacokinetic modeling and to determine the safety and efficacy of once daily ( OD ) gentamicin dosing in children with severe urinary tract infections ( UTI ) . Methods . An open , r and omized , controlled trial comparing OD with three times daily ( TD ) gentamicin dosing in hospitalized children ages 1 month to 12 years with UTI . Daily doses ( milligrams per kg per day ) of gentamicin in both groups were 7.5 ( < 5 years old ) , 6.0 ( 5 to 10 years old ) and 4.5 ( > 10 years old ) . Results . There were 179 children enrolled ( 90 OD , 89 TD ) . Baseline clinical characteristics and pathogens were similar , except that circulatory compromise and renal cortical scintigraphic defects were more common in the OD group . Median gentamicin treatment duration s were 3.0 ( OD ) and 2.7 ( TD ) days . Mean peak gentamicin concentrations were 17.3 ( OD ) vs. 6.4 ( TD ) mg/l ; 99 % of peak concentrations were > 7 mg/l in the OD group whereas 16 % of peak concentrations were < 5 mg/l in the TD group . Mean trough concentrations were 0.35 ( OD ) vs. 0.55 ( TD ) mg/l . In the OD group 4 % of trough concentrations were ≥2 mg/l , whereas in the TD group only 0.7 % were ≥2 mg/l . Age or prior elevated peak concentrations did not predict high trough concentrations . Population pharmacokinetic modeling of the data fitted a one-compartment model with first order elimination . There were no clinical or bacteriologic failures . The two disease-related complications were confined to the OD group . No nephro- or ototoxicity was identified . Conclusions . With age-appropriate dosing and measurement of serum trough concentrations before the second dose , OD gentamicin is safe and effective for the treatment of UTI requiring parenteral treatment in children aged 1 month to 12 years The pharmacokinetics of a low dose of sulfadiazine ( SD 4 mg/kg twice a day , loading dose 8 mg/kg ) were studied and acute urinary tract infection in children treated with this reduced dose . The concentrations of active SD in serum and urine were found to exceed those assumed to be sufficient for the treatment of acute urinary tract infections ( 10 x MIC and 100 x MIC against E. coli , respectively ; MIC = minimum inhibitory concentration ) . The urinary concentrations of both acetylated and non-acetylated SD remained lower than those considered to crystallize in the urinary tract . This suggests that renal damage earlier due to SD overdosage can be avoided by using the present administration . No difference was found in treatment results of  acute urinary tract infections in children between SD ( 4 mg/kg twice a day ) and  fulfafurazole  ( SF ; 50 mg/kg four times a day ) . Only infections caused by sulfonamide-sensitive micro-organisms were treated and all cases were cured . No side-effects could be recorded . SD in lower than the usual dosage would appear to be a practical alternative in the treatment of acute urinary tract infections caused by sulfonamide-sensitive micro-organisms in children Forty-nine ambulatory children between 2 - 1/2 and 12 years of age with acute , clinical ly uncomplicated urinary tract infections caused by susceptible organisms were r and omized to receive a single dose of amoxicillin based on weight or a 10-day course of amoxic 
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There were no significant differences between groups for persistent symptoms , recurrence following treatment , or re-infection following treatment .
There was insufficient data to analyse the effect of antibiotics on renal parenchymal damage , compliance , development of resistant organisms or adverse events .
Although antibiotic treatment is effective for children with UTI , there are insufficient data to answer the question of which type of antibiotic or which duration is most effective to treat symptomatic lower UTI .
This review found that 10-day antibiotic treatment is more likely to eliminate bacteria from the urine than single-dose treatments .
No differences were observed for persistent bacteriuria , recurrence or re-infection between short and long-course antibiotics where the antibiotic differed between groups .
This data adds to an existing Cochrane review comparing short and long-course treatment of the same antibiotic who also reported no evidence of difference between short and long-course antibiotics