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Short versus longer duration antibiotic treatment for urinary tract infections in companion animals: a systematic review and meta-analysis

BMC Veterinary Research volume 21, Article number: 280 (2025) Cite this article

Abstract

Background

Unnecessarily prolonged antibiotic durations may contribute to the development of resistance in both humans and animals. Veterinarians need evidence supporting antibiotic treatment durations. This systematic review and meta-analysis aimed to compare the efficacy of shorter durations of antibiotic treatment to longer durations in treating urinary tract infections (UTIs) in dogs and cats.

Methods

Four databases (MEDLINE, Scopus, EMBASE, and CAB Abstracts) were searched from inception to October 2nd, 2024. Studies that reported the impact of antibiotic treatments of different durations for simple UTIs in dogs or cats and reported a primary outcome of interest, specifically clinical or microbiological resolution of the UTIs, were included. For each study, two reviewers independently screened extracted data and evaluated the risk of bias. Random effects models were used to compare pooled risk ratios of cure rates.

Results

Of 2,324 studies screened, we identified three studies (two randomized and one nonrandomized controlled trial) which met our inclusion criteria for meta-analysis. Studies examined only 26 animals (9 events) across their short-duration arms and 28 animals (17 events) across long-duration arms. All studies were assessed as having high or serious risk of bias. The pooled risk ratio for cure with short versus longer durations of treatment was 0.55, 95% CI: 0.23–1.27; the evidence was graded as very low certainty. Studies compared 1 to 3-day durations, 3 days to 14-day and 3 days to 21-day durations.

Conclusion

Based on this data alone, we cannot make conclusions about the efficacy of short compared to long antibiotic durations for treating UTIs in cats and dogs; due to the low numbers of included studies and patients, the confidence intervals for the pooled risk ratio were wide and could be consistent with inferiority or superiority of shorter treatment. Existing evidence supports shorter durations of antibiotics for treating sporadic UTIs in dogs and cats, however this systematic review and meta-analysis highlights that this is still a serious knowledge gap that must be addressed. Studies that examine optimal antibiotic durations for treating UTIs in dogs and cats are urgently needed to support clinical decision-making, inform guidelines, and improve antimicrobial stewardship in veterinary medicine.

Systematic review registration

Open science framework (https://doiorg.publicaciones.saludcastillayleon.es/10.17605/OSF.IO/2YJPM).

Peer Review reports

Introduction

Antimicrobial resistance (AMR) is a serious public health threat. In 2021, it was estimated that AMR contributed to the deaths of almost 5 million people [1]. Antimicrobial use in animals is an important driver of AMR in humans [2, 3] which is why a One Health approach, meaning coordinated action across human, animal, and environmental sectors, is needed to address the growing threat of AMR [4].

Veterinarians need evidence and clinical guidelines to support their prescribing practices and reduce areas of potential misuse and overuse of antimicrobials like antibiotics [56]. In particular, in companion animal species, like cats and dogs, there is a need for additional research supporting antibiotic treatment regimens [7]. Not only will longer-duration antibiotic treatments potentially drive the development of resistant infections in animals in the future [8], but animals are also at higher risk of developing side effects with longer courses of antibiotics [9]. Additionally, longer treatment durations cost owners more and may result in reduced owner compliance [10]. Even for diseases for which antibiotics are commonly prescribed, such as urinary tract infections (UTIs) [11, 12] guidance is often based on human studies, and there is limited dog and cat-specific evidence available [13].

UTIs are the most common infectious disease in dogs, affecting 14% of dogs over their lifetime [14]. They are also one of the most common presenting issues resulting in an antibiotic prescription in both dogs and cats [11]. The International Society for Companion Animal Infectious Disease (ISCAID) recently updated its guidelines on treating UTIs in dogs and cats [15]. In the case of sporadic bacterial cystitis or simple UTIs, these guidelines recommend 3 to 5 days of treatment with amoxicillin or trimethoprim-sulfonamide. Prior to this update, ISCAID guidelines recommended longer durations of treatment for 7 days, and before 2011, durations of 10 to 14 days were recommended [16]. Although shorter durations of therapy are now recommended, these newly updated guidelines specifically highlight the lack of veterinary evidence supporting duration recommendations [15]. A 2021 study examining antibiotic prescriptions for dogs with suspect UTIs found that while durations had decreased in 2018 compared to 2016 and 2017, the median prescribed duration was still 10 days in 2018 [17]. Only one systematic review from 2015 has examined antibiotic efficacy and duration of treatment in UTIs in dogs [18].

To fill this knowledge gap, support clinical guideline adoption and guide veterinary prescribing practices, we conducted a systematic review and meta-analysis to answer the question: are shorter durations of antibiotic treatment as effective in treating simple urinary tract infections (as measured by clinical or microbiological cure) in dogs and cats when compared to longer antibiotic therapy duration?

Methods

Protocol and registration

This protocol was registered with Open Science Framework (https://doiorg.publicaciones.saludcastillayleon.es/10.17605/OSF.IO/2YJPM) and was developed in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. A populated PRISMA checklist is available as an Appendix (Appendix 1).

Inclusion and exclusion criteria

A full list of inclusion and exclusion criteria can be found in Table 1.

Table 1 Summary of inclusion and exclusion criteria
Full size table

Information sources

We searched the following databases to identify evidence published in scientific journals: MEDLINE (Ovid platform), Embase (Ovid platform), CAB Abstracts (Ovid platform), and Scopus (Elsevier platform). These databases were searched from inception to October 2nd, 2024; no publication date limits or limits on the language of publication were applied. Non-English studies were translated using Google Translate and included in the screening.

Search strategy

For each database, the search strategy was designed to retrieve records containing at least one search term (in major topic heading, title keyword, or natural language descriptor fields) related to the concept of antibiotics, urinary tract infections, domesticated cats or dogs and duration or treatment course. To identify relevant evidence on this topic, Public Health Ontario (PHO)’s Library Services [20] designed and executed our scientific literature searches. A copy of the full search strategy for each database can be found in Appendix 2.

Study selection

Title, abstract, and full-text screening were completed independently by two reviewers (FE, SO, ND, CM) in the systematic review software Covidence [21]. Any disagreements were resolved through consensus. We also hand-searched the cited references of all studies included in this review to identify any additional studies.

Data management and collection

Two reviewers independently extracted data for all included studies into a tailored Excel extraction form (FE, CM), which was tested first on two studies. Any conflicts that were identified were resolved through consensus. Researchers extracted general information on studies (author name and year of publication), study population parameters (species, number of animals, age/sex and health status of animals), disease information (induced or sporadic bacterial UTI, urine sampling method), antibiotic information (drug, dose, duration), primary outcomes (effect measure, evaluation time, evaluation method), and secondary outcomes (long term cure rates/measures, mortality, adverse events) if reported. If not reported, the raw data to calculate these effect measures were extracted instead. A full list of data items that were extracted can be found in Appendix 3.

Missing data

Missing data was recorded on extraction forms. Authors of included studies were contacted twice to provide missing data using corresponding author emails or public emails found by searching the web; studies were excluded in the event of author nonresponse if meta-analysis could not be performed with the available data.

Risk of bias

Risk of bias was assessed for included studies using two risk of bias tools: the Cochrane Risk of Bias 2 tool for randomized trials [22], which assesses studies as having high, low or some concerns for bias across five domains, and ROBINS-I [23] for non-randomized studies of interventions which assess studies as having low, moderate, serious or critical risk of bias across seven domains. The risk of bias was assessed by two reviewers (FE, CM) concurrently with data extraction, and consensus was used to resolve any disagreements.

Outcomes

To be included, studies needed to report on the primary outcome of interest: clinical or microbiological resolution of sporadic or induced urinary tract infections in dogs or cats after treatment as defined by authors. We assessed the efficacy of antibiotic durations continuously across a 1-day to > 14-day duration range. Examples of how authors might define the clinical resolution of symptoms are the resolution of polyuria, pollakiuria, haematuria, stranguria and/or dysuria, while microbiological cure was commonly defined as a negative aerobic bacterial urine culture or culture that yielded < 103 CFU/mL of bacteria. Secondary outcomes included long-term (14 to > 30 days) clinical or microbiological cure rates, mortality and any adverse events reported.

To be included the study must have compared the same antibiotic for both arms/comparison groups. We opted not to include studies which compareddifferent antibiotics in each arms/comparison group [24, 25] as we felt this might introduce variability which would make it difficult to directly compare outcomes and prevent pooling the results in a meaningful way (e.g. if we saw higher rates of side effects in shorter or longer arms it might be due to different side-effect profiles between the two antibiotics).

Summary effect measures for outcomes

We collected either (i) effect measures for both primary and secondary outcomes as odds or risk ratio if reported and associated measures of precision (confidence intervals) or (ii) the raw data needed to calculate odds or risk ratios for primary and secondary outcomes. If reported, adjusted variables reported by authors were also collected for each outcome.

Synthesis strategy

Study details were summarized descriptively. For the primary outcome, we compared short versus longer-duration antibiotic therapy groups using inverse variance random effects models and the Hartung-Knapp (HKSJ) adjustment method to calculate 95% confidence intervals (CI) [26]. Pooled effect sizes were reported as risk ratios (RR) with 95% CIs and presented as forest plots. We used the Restricted maximum-likelihood (REML) estimator approach to examine between-study variance (tau²). Finally, we also assessed heterogeneity visually in the generated forest plots and using the I [2] statistic (which reflects between-study heterogeneity). While we recognize that cats are not small dogs we opted to do a pooled meta-analysis across species as our primary analysis and examine species effects in sensitivity analyses, since the duration of antibiotics recommended is the same in both species [15]. All analyses were conducted in R statistical software [27].

Additional analyses

To examine the robustness of findings in our meta-analysis, we completed post-hoc sub-group analyses by species (since cats may be less affected by UTIs compared to dogs [28]), sex (since female dogs and cats are more predisposed to UTIs [29]) and antibiotic duration (since one study compared single-dose therapy to three days of treatment [30], which may also be considered short duration). For the sex sub-group analysis, raw data for female and male animals was used. Within study differences could not be pooled since one study was comprised of exclusively female animals. For all subgroup analyses, we used inverse variance random effects models and the Wald method to calculate 95% CIs [31]. The Wald method was used to calculate CIs for sub-group analyses since the HKSJ method adds additional between-subgroup heterogeneity. In these analyses, sub-groups were very small (1 or 2 studies). Pooled effect sizes were reported as RR with 95% CIs and presented visually as forest plots. For all subgroup analyses, we also assessed heterogeneity visually in the generated forest plots, using the I [2] statistic and examined between-study variance using tau². We planned to apply the Instrument for Assessing the Credibility of Effect Modification Analyses (ICEMAN) tool to assess the credibility of any subgroup analyses if p < 0.10.

Sensitivity analyses were performed to evaluate assumptions made when designing this systematic review. Sensitivity analyses were completed in the same manner as the primary meta-analysis. We evaluated the impact of study design and species on meta-analysis results by removing any observational and cat studies to examine randomized control trials and dog-only studies separately.

Certainty of evidence and publication bias

The quality of evidence for the primary outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system [32], and findings were presented as a summary table. GRADEpro software was used to calculate anticipated absolute effects of our risk ratio on 1000 animals [33]. Publication bias was assessed visually with a funnel plot.

Deviations from protocol

For our primary meta-analysis, the Hartung-Knapp method was chosen (in deviation from our registered protocol) since it can help correct for small-sample bias in the random effects model [26]. A second deviation from our protocol is that we used the Restricted maximum-likelihood (REML) estimator since it also performs better with small sample sizes to examine between-study variance (tau²) [34]. Finally, although we planned to exclude published conference abstracts, due to the limited number of studies identified, we opted to include abstracts which met other study selection criteria.

Results

Study selection

Of 2,324 citations screened, we identified four studies which met inclusion criteria [30, 35,36,37], however, one of these was excluded due to missing data and nonresponse from authors [37]. No additional studies were identified from hand-searching the reference lists of included studies. This study reported results combined across different durations and antibiotic types and could not be included in any analyses [37]. A PRISMA [38] flow chart (Fig. 1) depicts the study selection process and exclusion reasons.

Fig. 1
figure 1

A PRISMA flow diagram depicting the study selection process and exclusion reasons

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Study characteristics and findings

The three included studies evaluated 54 animals. Two studies looked at UTIs in dogs [30, 35]and one study at UTIs in cats [36]. All were conducted in laboratory animals and looked at the impact of different antibiotic durations on experimentally induced UTIs. Studies varied by antibiotic type, dose and duration. Two studies looked at durations of trimethoprim sulfadiazine [30, 35] one at amikacin [30] and one at amoxicillin [36] durations. No identified studies were published after 1990. Two studies examined single-dose therapy [30, 35], and one looked at three days as their shorter course [36]. Finally, since one study examined short versus long duration of therapy for two different antibiotics [30], each antibiotic was separately analyzed and each antibiotic is reported separately in Table 2. All included studies examined microbiological cure rates as their outcome. Full details on the characteristics of each study can be found in Table 2.

The first study examined the impact of single versus three days of trimethoprim sulfadiazine and amikacin on induced UTIs in mixed-breed dogs, finding microbiological cures were higher on day three, especially for dogs treated with trimethoprim sulfadiazine [30]. The second study examined three days versus 14 days of amoxicillin on induced UTIs in cats, finding slightly higher microbiological cures on day 1436. Finally, the third study examined microbiological cure rates of single-dose versus 21 days of trimethoprim sulfadiazine therapy on induced UTIs in only female dogs finding higher cure rates in animals treated with longer durations [35].

Table 2 Characteristics of studies included in this review
Full size table

Risk of bias

One study was a trial for which randomization was not fully described [36]. This study was assessed as having serious risk of bias, while the other two were randomized controlled trials, both assessed as having a high risk of bias [30, 35]. A concern in all studies was the use of experimentally induced urinary tract infections as a model for naturally occurring UTIs. The overall risk of bias for each study is listed in Table 2. The risk of bias across each domain is available for each study in Appendix 4.

Meta-analyses

The three studies reported the primary outcome (short versus long-duration antibiotic therapy cure rates for UTIs in dogs and cats) across 54 animals. The pooled risk ratio of short versus long duration of antibiotic therapy indicated lower cure rates with shorter duration treatment, but this was not statistically significant (RR 0.55, 95% CI: 0.23–1.27; very low certainty) (Fig. 2). The value of I [2] suggests low heterogeneity (15.2%, 95% CI 0.00–87.0), while tau² (0.078, 95% CI 0.00-11.5) suggests some degree of variability across studies. The large confidence interval of both measures, however, reflects the considerable uncertainty in both estimates. Secondary outcomes of interest, including long-term UTI cure rates or adverse events, were not reported.

Fig. 2
figure 2

Primary meta-analysis of cure rates with short versus long duration therapy for UTIs in dogs and cats. Since some studies have 0 events, 0.5 was added to all frequency counts in the meta-analysis. TMS is Trimethoprim/sulfamethoxazole

Full size image

Subgroup analyses identified no significant subgroup effects due to species (p = 0.19) (Fig. 3), sex (p = 0.14), or duration of therapy (p = 0.35) (Appendix 5). Since no significant difference in the effect between subgroups was found, we did not apply the ICEMAN tool to assess the credibility of any subgroup analyses. While other animal [40, 41] and disease factors [29] may also affect the robustness of our findings, both dog studies examined induced UTIs in mixed-breed, middle-aged dogs, thus breed and age sub-group analyses were not pursued.

Fig. 3
figure 3

Sub-group meta-analysis results of short versus long duration therapy microbiological cure rates for UTIs in dogs and cats by species. Since some studies have 0 events, 0.5 was added to all frequency counts in the meta-analysis. TMS is Trimethoprim/sulfamethoxazole.

Full size image

Sensitivity analysis

Sensitivity analyses by study type and species (dog and randomized controlled studies only) showed similar results to the primary meta-analysis (Appendix 6).

Publication bias

Due to a limited number of identified studies, publication bias was not assessed using the Egger test which will lack power with fewer than 10 studies. A Funnel plot of included studies (with the Rogers et al. study separated by antibiotic type) is available in Appendix 7. Visual assessment of the funnel plot does not show obvious asymmetry however due to the lack of studies these findings are less reliable.

Summary of findings and grade assessment of certainty of evidence

Evidence supporting our primary outcome was evaluated as having a very low certainty of evidence due to a high risk of bias across studies and high indirectness due to most studies using experimentally induced urinary tract infections, which may not be reflective of sporadic simple UTIs and microbiological cure as their outcome instead of clinical cure which is less relevant from a patient, owner and veterinarian perspective. Studies also had high imprecision due to our potential risk of publication bias with only older studies identified and because our confidence intervals reflect that longer durations could be better or worse than shorter durations, making our result uncertain. This imprecision is further reflected in our large anticipated absolute effect range which showed that shorter durations of antibiotics may cure 467 fewer animals or up to 164 more animals than longer durations. While 467 fewer animals cured out of 1000 would be clinically relevant, 164 more might not be. A full summary of the assessment of the certainty of evidence for the primary outcome is available in Table 3.

Table 3 Grade assessment of the certainty of evidence for primary outcome
Full size table

Discussion

Using current data, we were not able to show significant differences in microbiological cure rates between shorter durations of antibiotics compared to longer durations when treating urinary tract infections in dogs and cats. The meta-analysis of our primary outcome was non-statistically significant (RR 0.55, 95% CI: 0.23–1.27; very low certainty). A small sample size of animals included in studies (with only a total of 54 animals) may have contributed to our findings. Additionally, that studies examined different durations and only considered microbiological cures may have also influenced these findings. We were not able to examine any secondary outcomes, such as long-term UTI cure rates or adverse events, as these outcomes were not reported in the included studies. For adverse events, this may reflect that either the studies did not capture this outcome or that none occurred.

No other meta-analyses have examined the efficacy of different antibiotic therapy durations for treating urinary tract infections in dogs and cats. The lack of studies found by this review echoes the lack of evidence highlighted by ISCAID guidelines on treating UTIs in dogs and cats [15] and the findings of a similar 2015 systematic review in dogs [18], which was unable to perform a meta-analysis since not enough studies were identified.

Limitations

Firstly, while measures of between-study heterogeneity and variance were low, confidence intervals for these measures were large, meaning both measures are uncertain. Included studies varied by species (cats and dogs), study design and antibiotic type, dose and duration. For the duration, all three studies compared different durations, with one study comparing single-dose therapy to three doses, which could still be considered short-duration. Additionally, the other studies both examined quite long durations in their long arms with one study comparing single-dose therapy to 21 days of therapy, a much longer duration than would traditionally be used for sporadic bacterial UTIs. In women, single-dose therapy has been shown to be less effective in treating uncomplicated cystitis, although this may depend on the antibiotic and dose [42, 43].

Secondly, the studies included in this review may not have accurately captured the population and disease of interest. Studies included male and female animals, even though UTIs are more common in female animals [44]. Additionally, urinary tract infections in male animals are more likely to involve the prostate and require longer durations of antibiotics [15]. All included studies also used experimentally induced UTIs. Induced UTIs are likely not reflective of naturally occurring sporadic bacterial UTIs, and reported cure rates may not reflect cure rates for naturally occurring UTIs. Two of the studies induced bacterial infections using Staphylococcus intermedius, whereas Escherichia coli is the most common bacteria isolated from urinary tract infections in pets [45]. Finally, all three studies looked at microbiological cures as their outcome; future trials examining clinical cures as reported by owners will be more pragmatic and relevant to both veterinarians, owners and the animals themselves For owners and veterinarians clinical cure is a more relevant outcome when each urinalysis and/or culture represents an additional vet visit and cost. For the patients or animals clinical cure is also a more useful outcome since an unsuccessful microbiological cure in the absence of clinical signs is classified as subclinical bacteriuria and should not require further antibiotic treatment [15].

Like most systematic reviews, publication bias may also have impacted our results. Although we designed our search strategy to search across multiple sources, included studies published at any time and hand-searched across reference lists of identified studies, few and only older studies were identified. This smaller number of studies included means our funnel plot, which was symmetrical, should be interpreted cautiously and may be inaccurate.

While we were not able to show significant differences in microbiological cure rates between shorter and longer durations of antibiotic therapy these findings do not in any way contradict the updated ISCAID guidelines which recommend 3 to 5 days of antibiotic therapy for treating sporadic UTIs in dogs and cats [15]. In humans, similar durations are well supported [46, 47]. In order to make clear clinical recommendations to veterinarians going forward, our findings highlight the need for additional, high-quality studies from veterinary settings.

Conclusions

High-quality evidence will inform clinical guidelines and modernize the clinical practice of small animal veterinarians. The prudent use of antimicrobials is essential for maintaining the effectiveness of antimicrobials for use in both humans and animals [48], which is why the World Health Organization has prioritized addressing antimicrobial use in animals [49]. Our findings highlight the need for additional high-quality, larger clinical trials examining antibiotic duration for treating simple, naturally occurring UTIs in both dogs and cats. Secondary outcomes such as long-term UTI cure rates should also be investigated, and adverse events should be explicitly reported. These studies will support veterinary clinical decision-making, inform clinical guidelines and ultimately improve antimicrobial stewardship in veterinary medicine.

Data availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

References

  1. Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050| Institute for Health Metrics and Evaluation. Accessed October 5. 2024. https://www.healthdata.org/research-analysis/library/global-burden-bacterial-antimicrobial-resistance-1990-2021-systematic

  2. Jin M, Osman M, Green BA, et al. Evidence for the transmission of antimicrobial resistant bacteria between humans and companion animals: A scoping review. One Health. 2023;17. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.onehlt.2023.100593.

  3. Wegener HC, Antibiotic resistance—linking human. and animal health. in: Improving Food Safety Through a One Health Approach: Workshop Summary. National Academies Press (US); 2012. Accessed August 1, 2024. https://www.ncbi.nlm.nih.gov/books/NBK114485/

  4. EClinicalMedicine. Antimicrobial resistance: a top ten global public health threat. eClinicalMedicine. 2021;41. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.eclinm.2021.101221.

  5. Yudhanto S, Varga C. Knowledge and attitudes of small animal veterinarians on antimicrobial use practices impacting the selection of antimicrobial resistance in dogs and cats in Illinois, united States: A Spatial epidemiological approach. Antibiotics. 2023;12(3):542. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/antibiotics12030542.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Maruve SA, Essack SY. Knowledge, attitudes, and practices of veterinarians on antibiotic use and resistance and its containment in South Africa. J S Afr Vet Assoc. 2022;93(2):1–10. https://doiorg.publicaciones.saludcastillayleon.es/10.36303/JSAVA.164.

    Article  Google Scholar 

  7. Critically important antimicrobials for human medicine: 6th revision. Accessed July 7. 2024. https://www.who.int/publications/i/item/9789241515528

  8. Mathers JJ, Flick SC, Cox LA. Longer-duration uses of tetracyclines and penicillins in U.S. food-producing animals: indications and microbiologic effects. Environ Int. 2011;37(5):991–1004. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.envint.2011.01.014.

    Article  CAS  PubMed  Google Scholar 

  9. Rocholl C, Zablotski Y, Schulz B. Online-Assisted survey on antibiotic use by pet owners in dogs and cats. Antibiotics. 2024;13(5):382. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/antibiotics13050382.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Candellone A, Badino P, Girolami F, Ala U, Mina F, Odore R. Dog owners’ attitude toward veterinary antibiotic use and antibiotic resistance with a focus on canine diarrhea management. Animals. 2023;13(6):1061. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/ani13061061.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hur B, Hardefeldt LY, Verspoor KM, Baldwin T, Gilkerson JR. Evaluating the dose, indication and agreement with guidelines of antimicrobial use in companion animal practice with natural Language processing. JAC-Antimicrob Resist. 2022;4(1):dlab194. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/jacamr/dlab194.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Bloch RA, Papich MG, Stürmer T. Veterinary antimicrobial prescribing practices for treatment of presumptive sporadic urinary tract infections in dogs examined at primary care practices in the united States (2010–2019). Published Online June. 2022;1. https://doiorg.publicaciones.saludcastillayleon.es/10.2460/javma.21.03.0123.

  13. Allerton F, Pouwels KB, Bazelle J, et al. Prospective trial of different antimicrobial treatment durations for presumptive canine urinary tract infections. BMC Vet Res. 2021;17(1):299. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12917-021-02974-y.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Pharmacotherapeutics in Bacterial Urinary Tract Infections in Animals - Pharmacology. Merck Veterinary Manual. Accessed August 20. 2024. https://www.merckvetmanual.com/pharmacology/systemic-pharmacotherapeutics-of-the-urinary-system/pharmacotherapeutics-in-bacterial-urinary-tract-infections-in-animals

  15. International Society for Companion Animal Infectious Diseases (ISCAID) guidelines for the diagnosis and management of bacterial urinary tract infections in dogs and cats. Accessed August 20. 2024. https://www.jstage.jst.go.jp/article/javnu/13/1/13_46/_article/-char/ja/

  16. Weese JS, Blondeau JM, Boothe D, et al. Antimicrobial use guidelines for treatment of urinary tract disease in dogs and cats: antimicrobial guidelines working group of the international society for companion animal infectious diseases. Vet Med Int. 2011;2011(1):263768. https://doiorg.publicaciones.saludcastillayleon.es/10.4061/2011/263768.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Weese JS, Webb J, Ballance D, McKee T, Stull JW, Bergman PJ. Evaluation of antimicrobial prescriptions in dogs with suspected bacterial urinary tract disease. J Vet Intern Med. 2021;35(5):2277–86. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/jvim.16246.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Jessen LR, Sørensen TM, Bjornvad CR, Nielsen SS, Guardabassi L. Effect of antibiotic treatment in canine and feline urinary tract infections: A systematic review. Vet J. 2015;203(3):270–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.tvjl.2014.12.004.

    Article  CAS  PubMed  Google Scholar 

  19. Bero L, Deane K, Eccles M et al. Cochrane effective practice and organisation of care review group (Cochrane group module). Cochrane Libr. 2009;3.

  20. Library Services. Public Health Ontario. Accessed December 12. 2024. https://www.publichealthontario.ca/en/Health-Topics/Public-Health-Practice/Library-Services

  21. Covidence - Better systematic review management. Covidence. Accessed December 12. 2024. https://www.covidence.org/

  22. Higgins JP. The Cochrane Collaboration’s Tool for Assessing Risk of Bias in Randomised Trials. Cochrane Collab. Published online 2011.

  23. Seo HJ, Kim SY, Lee YJ, Park JE. RoBANS 2: A revised risk of bias assessment tool for nonrandomized studies of interventions. Korean J Fam Med. 2023;44(5):249–60. https://doiorg.publicaciones.saludcastillayleon.es/10.4082/kjfm.23.0034.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Clare S, Hartmann FA, Jooss M, et al. Short- and long-term cure rates of short-duration trimethoprim-sulfamethoxazole treatment in female dogs with uncomplicated bacterial cystitis. J Vet Intern Med. 2014;28(3):818–26. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/jvim.12324.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Westropp JL, Sykes JE, Irom S, et al. Evaluation of the efficacy and safety of high dose short duration Enrofloxacin treatment regimen for uncomplicated urinary tract infections in dogs. J Vet Intern Med. 2012;26(3):506–12. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/j.1939-1676.2012.00914.x.

    Article  CAS  PubMed  Google Scholar 

  26. Röver C, Knapp G, Friede T. Hartung-Knapp-Sidik-Jonkman approach and its modification for random-effects meta-analysis with few studies. BMC Med Res Methodol. 2015;15(1):99. https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12874-015-0091-1.

    Article  PubMed  PubMed Central  Google Scholar 

  27. R Core Team R. R: A language and environment for statistical computing. Published online 2013. Accessed August 1. 2024. https://apps.dtic.mil/sti/citations/AD1039033

  28. Dorsch R, Teichmann-Knorrn S, Sjetne Lund H. Urinary tract infection and subclinical bacteriuria in cats: A clinical update. J Feline Med Surg. 2019;21(11):1023–38. https://doiorg.publicaciones.saludcastillayleon.es/10.1177/1098612X19880435.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ling GV, Norris CR, Franti CE, et al. Interrelations of organism prevalence, specimen collection method, and host age, sex, and breed among 8,354 canine urinary tract infections (1969–1995). J Vet Intern Med. 2001;15(4):341–7. https://doiorg.publicaciones.saludcastillayleon.es/10.1111/j.1939-1676.2001.tb02327.x.

    Article  CAS  PubMed  Google Scholar 

  30. Rogers KS, Lees GE, Simpson RB. Effects of single-dose and three-day trimethoprim-sulfadiazine and Amikacin treatment of induced Escherichia coli urinary tract infections in dogs. Am J Vet Res. 1988;49(3):345–9.

    Article  CAS  PubMed  Google Scholar 

  31. Viechtbauer W. Confidence intervals for the amount of heterogeneity in meta-analysis. Stat Med. 2007;26(1):37–52. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/sim.2514.

    Article  PubMed  Google Scholar 

  32. Schünemann H, Brożek J, Guyatt G, Oxman A. The GRADE handbook. Published online 2013. Accessed March 10, 2025. https://hero.epa.gov/hero/index.cfm/reference/details/reference_id/10284249

  33. GRADEpro. Accessed March 10, 2025. https://www.gradepro.org/

  34. Kontopantelis E, Reeves D. Performance of statistical methods for meta-analysis when true study effects are non-normally distributed: A comparison between DerSimonian–Laird and restricted maximum likelihood. Stat Methods Med Res. 2012;21(6):657–9. https://doiorg.publicaciones.saludcastillayleon.es/10.1177/0962280211413451.

    Article  PubMed  Google Scholar 

  35. Turnwald GH, Gossett KA, Cox HU, et al. Comparison of single-dose and conventional trimethoprim-sulfadiazine therapy in experimental Staphylococcus intermedius cystitis in the female dog. Am J Vet Res. 1986;47(12):2621–3.

    Article  CAS  PubMed  Google Scholar 

  36. Mann MA, Davenport DJ, Troy GC, Inzana T. Efficacy of short term amoxicillin therapy in experimentally induced UTI in cats. J Vet Intern Med. 1990;4(2):126.

    Google Scholar 

  37. Cotard JP, Gruet P, Pechereaut D, et al. Comparative study of Marbofloxacin and amoxicillin-clavulanic acid combination in the treatment of urinary tract infections in the dog. Estud Comp Entre Marbofloxacina Amoxicilina-Acido Clavulanico En El Trat Infecc Tracto Urin En Perros. 1995;5(4):179–83.

    Google Scholar 

  38. PRISMA 2020 flow diagram. PRISMA statement. Accessed August 30. 2024. https://www.prisma-statement.org/prisma-2020-flow-diagram

  39. Mann MA. The Efficacy of Short Term Amoxicillin Therapy and the Effect of Furosemide on Conventional Antibiotic Therapy in Experimentally Induced Bacterial Lower Urinary Tract Infection in Cats. Virginia Tech; 1991. Accessed December 12, 2024. http://hdl.handle.net/10919/41701

  40. Norris C, Williams B, Ling G, Franti C, Johnson, Ruby A. Recurrent and persistent urinary tract infections in dogs: 383 cases (1969–1995). J Am Anim Hosp Assoc. 2000;36(6):484–92. https://doiorg.publicaciones.saludcastillayleon.es/10.5326/15473317-36-6-484.

    Article  CAS  PubMed  Google Scholar 

  41. Hooijmans CR, IntHout J, Ritskes-Hoitinga M, Rovers MM. Meta-Analyses of animal studies: an introduction of a valuable instrument to further improve healthcare. ILAR J. 2014;55(3):418–26. https://doiorg.publicaciones.saludcastillayleon.es/10.1093/ilar/ilu042.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Antibiotic duration for. Treating uncomplicated symptomatic lower urinary tract infection in elderly women. https://doiorg.publicaciones.saludcastillayleon.es/10.1002/14651858.CD001535.pub2

  43. Single-Dose Antibiotic Treatment for Uncomplicated Urinary Tract Infections: Less for Less?| JAMA Internal Medicine| JAMA Network. Accessed December 4. 2024. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/606110

  44. Antimicrobial Resistance Trends in Dogs and Cats with Urinary Tract Infection| SpringerLink. Accessed December 4. 2024. https://link.springer.com/chapter/10.1007/978-3-030-61981-7_13

  45. Aurich S, Prenger-Berninghoff E, Ewers C. Prevalence and antimicrobial resistance of bacterial uropathogens isolated from dogs and cats. Antibiotics. 2022;11(12):1730. https://doiorg.publicaciones.saludcastillayleon.es/10.3390/antibiotics11121730.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Kaußner Y, Röver C, Heinz J, et al. Reducing antibiotic use in uncomplicated urinary tract infections in adult women: a systematic review and individual participant data meta-analysis. Clin Microbiol Infect. 2022;28(12):1558–66. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.cmi.2022.06.017.

    Article  PubMed  Google Scholar 

  47. Katchman EA, Milo G, Paul M, Christiaens T, Baerheim A, Leibovici L. Three-day vs longer duration of antibiotic treatment for cystitis in women: systematic review and meta-analysis. Am J Med. 2005;118(11):1196–207. https://doiorg.publicaciones.saludcastillayleon.es/10.1016/j.amjmed.2005.02.005.

    Article  CAS  PubMed  Google Scholar 

  48. World Bank. Drug-Resistant Infections: A Threat to Our Economic Future, World Bank. 2017:172. Accessed June 11, 2024. https://documents1.worldbank.org/curated/en/323311493396993758/pdf/final-report.pdf

  49. World Health Organization. Global Action Plan on Antimicrobial Resistance. World Health Organization. 2015. Accessed March 2, 2022. https://apps.who.int/iris/handle/10665/193736

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Acknowledgements

We would like to thank Kayla Strong for reviewing the search strategy.

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Authors and Affiliations

  1. Public Health Ontario, Toronto, ON, Canada

    Fiona Emdin, Valerie Leung, Kevin L. Schwartz, Bradley J. Langford, Kevin A. Brown, Susan Massarella & Nick Daneman

  2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Fiona Emdin, Sean W. X. Ong & Nick Daneman

  3. Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Sean W. X. Ong & Nick Daneman

  4. Global Strategy Lab, York University, Toronto, ON, Canada

    Fiona Emdin & Clare McGall

  5. Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada

    Kevin L. Schwartz

  6. Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada

    Kevin L. Schwartz, Bradley J. Langford & Kevin A. Brown

  7. Department of Infectious Diseases, at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia

    Sean W. X. Ong

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Contributions

FE: Writing - Original Draft, Writing - Review & Editing, Methodology, Guarantor. ND: Writing - Review & Editing, Conceptualization, Methodology. KS, BL, KB, VL: Writing - Review & Editing, Conceptualization, Methodology. SM: Search Strategy Development, Methodology. SO, CM: Study screening, Review & Editing.

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Emdin, F., Ong, S.W.X., McGall, C. et al. Short versus longer duration antibiotic treatment for urinary tract infections in companion animals: a systematic review and meta-analysis. BMC Vet Res 21, 280 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12917-025-04722-y

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BMC Veterinary Research

ISSN: 1746-6148

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