Treatment choices

Administration

Administration route of antibacterial therapy:

  • The choice between oral and parenteral therapy should be based on patient age, clinical suspicion of urosepsis; illness severity, refusal of fluids, food and/or oral medication, vomiting, diarrhea; non-compliance, and complicated pyelonephritis.
  • As a result of the increased incidence of urosepsis and severe pyelonephritis in newborns and infants aged less than two months, parenteral antibiotic therapy is recommended. Electrolyte disorders with life-threatening hyponatremia and hyperkalemia based on pseudohypoaldosteronism can occur in these cases.

Agents

Choosing agents by patients:
The choice of agent is also based on local antimicrobial sensitivity patterns, and should later be adjusted according to sensitivity-testing of the isolated uropathogen.

  • In children who require intravenous treatment, tobramycin or gentamicin is recommended if there is normal kidney function.
  • When abnormal kidney function is suspected, ceftriaxon or cefotaxime are alternative treatment options.
  • In children who can receive oral treatment without any known resistant urinary cultures, cefixime or amoxicillin-clavulanate are the empirical treatment options.

Keep in mind: Delaying treatment in children with a febrile UTI for more than 48-72 hours increases the risk of renal scars.

Antibiotic Breakdown

Antimicrobial agents:
The choice of antibiotics should be guided by good antibiotic stewardship.

  • It is important to be aware of the local resistance patterns

    These are variable between countries and moreover between hospitals. Local antibiotic protocols and web-based recommendations can guide the choice for type of antibiotic therapy.

  • The individual patient’s previous urine cultures should also be taken into account in this decision.

  • The daily dosage of antibiotics is dependent on the age and weight of the child, as well as on renal and liver function.

Chemoprophylaxis

Chemoprophylaxis is commonly used to prevent UTIs in children.
What to look out for:

  • With the increasing bacterial resistance numbers, it should be carefully considered which patients should receive antibacterial prophylaxis.
  • The evidence for the use of antibacterial prophylaxis has been conflicting.
  • Its use causes a reduction of the number of recurrent symptomatic UTIs, but long-term use of antibacterial prophylaxis has also been associated with increased microbial resistance.
  • Keep in mind: Trimethoprim, Trimethoprim-Sulfamethoxazole, Sulfamethoxazole, Nitrofurantoin, Cefaclor, Cefixim are agents that can be used for prophylaxis.

Duration of therapy

Prompt adequate treatment of UTI can prevent the spread of infection and renal scarring
Children with bacteremia receive longer parenteral treatment.
Simple cystitis can be treated with 3-5 days of antibiotics
Treat febrile UTIs with four to seven-day courses of oral or parenteral therapy.

UTI & VUR
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