Urinary%20tract%20infection%20(pediatric) Treatment
Principles of Therapy
Consider Hospital Admission in the Following Patients:
- Who need intravenous (IV) fluids
- Who need intravenous (IV) antibiotics because of severe illness
- Unresponsive to oral antibiotics
- ≤4 months of age
- W/ questionable compliance w/ treatment
- W/ difficulty w/ follow-up
- W/ whom clinician or family is uncomfortable managing the patient as an outpatient
Outpatient Pharmacotherapy
- Starting empiric treatment w/ a broad-spectrum antibiotic is recommended in a patient w/ presumptive urinary tract infection (UTI) once a specimen for culture & urinalysis, preferably obtained from catheterization or suprapubic bladder aspiration (SPA), is sent
- The agent to be given should be based on the antibiotic susceptibility patterns of the infecting pathogen
- Timely treatment w/ antibiotics decreases the severity of renal scarring
- Local resistance patterns must be considered when choosing an antibiotic
- Practicality should be considered when deciding which route of administration of treatment is to be chosen
- Oral treatment has the same efficacy as that of parenterally administered therapies
- Parenteral outpatient treatment may be administered to patients w/ acute pyelonephritis but do not require hospital admission
Cephalosporins
- 1st-, 2nd- & 3rd-generation cephalosporins may be used in the treatment of urinary tract infection (UTI)
- Oral Cefixime has been shown to be cost-effective & efficacious
Penicillins
- Eg Amoxicillin, Ampicillin, Co-amoxiclav
Quinolones
- Eg Ciprofloxacin, Nalidixic acid
- Provides excellent coverage against Gram-positive & Gram-negative organisms in the urinary tract
- Drug-induced arthrotoxicity shown in animal models has discouraged use in children, although they may still be considered in the treatment of urinary tract infection (UTI)
Others
- Co-trimoxazole
- Nitrofurantoin
- Not considered adequate for pyelonephritis because of poor tissue penetration
- May be used to treat cystitis in older children
Treatment Modification
- Antibiotic treatment may need to be modified based on urine culture, however changing antibiotics may not be necessary if clinical resolution occurs
- If the patient’s condition does not improve after 24-48 hours of treatment, re-evaluation should be done
Duration of Treatment
Lower Urinary Tract Infection (UTI)/Cystitis
- Short courses (2-4 days) of treatment may be equally effective as longer courses (7-14 days) for older patients
Upper UTI/acute pyelonephritis
- A 7-14 day course of antibiotics should be given to patients w/ upper UTI/acute pyelonephritis
Inpatient Pharmacotherapy
- An immunocompromised patient or infant younger than 2 mth is assumed to have acute pyelonephritis or complicated urinary tract infection (UTI) & should be managed in the hospital
Parenteral Antibiotic Therapy
- Ampicillin or cephalosporin plus aminoglycoside (eg Gentamicin, Tobramycin) cover most urinary tract pathogens
- Once-daily dosing is recommended for patients receiving aminoglycosides
- Ampicillin provides coverage against Gram-positive cocci or Enterococcus
- 3rd- or 4th-generation cephalosporin may be used as an alternative initial treatment when antimicrobial resistance is increasing or when there is concern about adverse reactions (eg nephrotoxicity)
- Eg Ceftazidime, Cefotaxime, Ceftriaxone
- Co-amoxiclav may also be used
- If intravenous (IV) treatment is not possible in a patient who requires parenteral therapy, then intramuscular (IM) treatment should be considered
Shifting to Oral Antibiotic Therapy (Switch Therapy)
- Parenteral treatment is given until patient is clinically stable & afebrile for 48-72 hours
- A short course of intravenous (IV) antibiotics followed by oral antibiotics is as effective as a longer duration of intravenous (IV) antibiotics
- Please see Pharmacological therapy – Outpatient for options for oral antibiotic therapy
Duration of Treatment
- A 7-14 day course of antibiotics should be given to patients w/ upper urinary tract infection (UTI)/acute pyelonephritis