You will be presented with a collection of medical randomized controlled trial (RCT) reports addressing a shared clinical question -- for instance, the efficacy of a medical intervention on a disease or condition. Given the titles and abstracts of these reports, your task is to generate the conclusion of the systematic review article synthesizing the key findings. Your conclusion should be a few sentences long. In your response, include only the conclusion and no other text. The RCT reports are below.



Title 1:
The role of bacterial adhesins in the outcome of childhood urinary tract infections.
Abstract 1:
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


Title 2:
Evaluation of short-term antibiotic therapy in children with uncomplicated urinary tract infections.
Abstract 2:
This study was design ed to determine whether serum C-reactive protein ( CRP ) concentrations could be used to identify children with uncomplicated lower urinary tract infection who would respond favorably to short-term antibiotic therapy .  A one-day or ten-day regimen of cefadroxil ( 30 mg/kg/day in two divided doses ) was assigned r and omly to 80 children who had acute urinary tract infection and CRP concentrations less than 28 microgram/ml ( CRP-negative group ) . Ten days of cefadroxil therapy was used to treat 44 children with urinary tract infection and CRP values greater than or equal to 28 microgram/ml ( CRP-positive group ) . The clinical and laboratory characteristics of the children in the two CRP-negative therapy groups were similar to , but different from those of children with CRP-positive infections .  Recurrent infections occurred significantly more often at four to five days after completion of therapy in CRP-negative children who received one day ( 44.4 % ) compared to ten days ( 20 % ) of cefadroxil therapy ( P less than .05 ) . When data from this study were combined with those from our previously published investigation of short-term antibiotic therapy in CRP-negative children , a significantly larger percentage of recurrences was documented immediately after one or four days of antibiotics ( 79 % ) compared to recurrences after the st and ard ten-day regimen ( 41 % ) . Additionally , the total rate of recurrent infections for all children in both studies was significantly larger in those who received short-term therapy ( 48 % ) as opposed to conventional therapy ( 34 % ) . These data indicate that short-term antibiotic therapy is less effective than the conventional ten-day regimen in children with CRP-negative urinary tract infection


Title 3:
Nalidixic acid and trimethoprim/sulphamethoxazole as alternatives for short-term treatment of urinary infections.
Abstract 3:
The efficacy of 3-day therapy with nalidixic acid in 16 children , and trimethoprim/sulphamethoxazole in 19 children , was studied prospect ively in children with an acute infection of the lower urinary tract and compared with that of a conventional 10-day course with the same drugs . The immediate cure rate was 97 % in the 3-day group and 90 % in the 10-day group . During 3 months of follow-up there were altogether six re-infections in children given short-term treatment and six in the conventionally treated group . The results give further support for the suggestion that 3-day therapy is equivalent to 10-day treatment in uncomplicated urinary  infections in children and that both nalidixic acid and trimethoprim/sulphamethoxazole are good alternatives in such an approach


Title 4:
Diagnostic value of a P-fimbriation test in determining duration of therapy in children with urinary tract infections.
Abstract 4:
The patients were 117 children ( aged 4 months to 14 years ) with uncomplicated urinary tract infections caused by co-trimoxazole-sensitive Escherichia coli . The patients were r and omly assigned to receive treatment with co-trimoxazole for 3 days ( n = 58 ) or 7 days ( n = 59 ) . Urine was analyzed for bacteria before and immediately after treatment and again at 1 and 2 months . After 3 days ' treatment , infection persisted in 14 of 31 patients with P-fimbriated strains of E coli and in 1 of 27 patients with non-P-fimbriated strains . After 7 days ' treatment , infection persisted in 2 of 40 patients with fimbriated strains and in none of the 19 patients with nonfimbriated strains . One or 2 months after treatment , 3 days ' treatment was rated successful in 26 of 27 patients with nonfimbriated strains and in none of the patients with fimbriated strains . Seven days ' treatment was rated successful in all patients with nonfimbriated strains and in 32 of 40 patients with fimbriated strains . The results indicate that the length of treatment of urinary tract infections in children should be adjusted according to the presence of bacterial P-fimbriae in addition to the patients ' clinical condition


Title 5:
Single daily doses of trimethoprim/sulphadiazine for three or 10 days in urinary tract infections
Abstract 5:
We conducted a prospect i ve r and omized study to evaluate the efficacy of a single daily dose of 4 mg/kg of trimethoprim coupled with 17.5 mg/kg of sulphadiazine for three ( group 1 ) or 10 days ( group 2 ) in the treatment of uncomplicated urinary tract infections in children . Forty patients ( nine boys and 31 girls ) aged 2.5‐18 years , presenting with a urinary tract infection were allocated to one of the two groups . Patients were seen three , 10 , and 38 days after the initiation of treatment . Control urine cultures were negative in all patients at days 3 and 10 . Two patients in group 1 and one patient in group 2 suffered a relapse within a month . Single doses of trimethoprim/sulphadiazine for three or 10 days are effective in the treatment of uncomplicated  urinary  tract infections in children


Title 6:
Single dose antibiotic therapy is not as effective as conventional regimens for management of acute urinary tract infections in children
Abstract 6:
One hundred thirty-two children with acute urinary tract infection were r and omly assigned to receive trimethoprim-sulfamethoxazole in one dose , two doses daily for 3 days or two doses daily for 7 days . The patient characteristics , etiologic agents and frequency of roentgenologic abnormalities were similar for the three treatment groups . There was no significant difference in bacteriologic cure rates for the single dose regimen ( 93 % ) and multidose regimens ( 96 % ) . The difference in rates of recurrent urinary tract infection between the single dose ( 20.5 % ) and 3-day ( 5.6 % ) and 7-day ( 8 % ) regimens was statistically significant ( P = 0.033 ) . A single dose of trimethoprim-sulfamethoxazole is inadequate treatment for infants and children with acute urinary tract infection


Title 7:
Two-day therapy with cefuroxime axetil is effective for urinary tract infections in children.
Abstract 7:
Short-course therapy for pediatric urinary tract infection ( UTI ) remains controversial . The present study was undertaken to compare the effectiveness of cefuroxime axetil ( Ceftin ) as short-course ( 2-day ) versus conventional ( 10-day ) therapy for uncomplicated pediatric UTIs . In a r and omized , controlled , prospect i ve study , we enrolled 50 children , 2 - 11 years of age , to receive oral cefuroxime axetil , 125 mg twice a day , for either 2 or 10 days . UTI was defined as at least 10(5 ) colonies/ml of a single pathogen isolated on clean catch , or at least 10(4 ) colonies/ml on a catheterized specimen . A 10-fold or greater reduction in colony count of the initially isolated organism ( 3 - 5 ) days after stopping therapy was considered a bacteriologic success , as long as the absolute colony count was below the threshold for UTI described above . Patients were followed for 15 months with multiple repeat urine cultures and radiologic studies . Twenty-five of the 50 patients enrolled were withdrawn , including 12 for initially inadequate colony counts . Eight of 12 patients in the short-course group ( 67 % ) , versus 12 of 14 in the conventional-therapy group ( 86 % ) , were initial bacteriological successes , a nonsignificant difference . All 37 initially isolated uropathogens were sensitive to cefuroxime axetil in vitro . Cefuroxime axetil is an effective antimicrobial for uncomplicated pediatric UTIs . Two-day therapy with cefuroxime axetil appears to be as effective as 10-day therapy , although sample size was limited in this study
A 2 - 4 day course of oral antibiotics is as effective as 7 - 14 days in eradicating lower tract UTI in children