Which medications are used in the treatment of pediatric urinary tract infection (UTI)?

Updated: Mar 19, 2019
  • Author: Donna J Fisher, MD; Chief Editor: Russell W Steele, MD  more...
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Antibiotics are used to treat urinary tract infection (UTI) and, in select patients, to prevent recurrence. Avoid nephrotoxic drugs whenever possible. On occasion, analgesic therapy may be used to provide relief because of voiding symptoms.

Start antibiotics after performing urinalysis and obtaining a urine specimen for culture in patients with UTI. A 7- to 10-day course of antibiotics is recommended, even for an uncomplicated infection. Short-course treatments should be reserved for nontoxic-appearing adolescent girls with UTI. Be aware of increasing rates of antibiotic resistance and the need to choose antibiotic therapy accordingly.

Empiric antibiotics should be chosen for coverage of the most common uropathogens, namely Escherichia coli and Enterococcus, Proteus, and Klebsiella species. Oral antibiotics are adequate therapy for febrile UTIs in young infants and children.

The possibility of antibiotic resistance must be considered when choosing empiric therapy, especially with ampicillin. Knowledge of the local antibiotic resistance helps in guiding antibiotic choice.

A study by Bryce et al that reviewed studies investigating the prevalence of antibiotic resistance in UTI caused by E. coli in children found that the prevalence of resistance is high, particularly in countries outside the Organization for Economic Co-operation and Development (OECD). Resistance in countries outside the OECD was: 79.8% for ampicillin, 60.3% for co-amoxiclav, 26.8% for ciprofloxacin, and 17.0% for nitrofurantoin. [60]

In a study of 607 children with reflux diagnosed by VCUG after a first or second UTI, the subjects were randomized to antibiotic prophylaxis with TMP-SMX or placebo. The risk of recurrences was reduced by 50% in the treatment group (hazard ratio, 0.50; 95% CI, 0.34-0.74). The risk of renal scarring overall did not differ significantly between the groups over 2 years. Also, the occurrence of a subsequent UTI with a TMP-SMX — resistant organism was significantly increased in the treatment group. The children enrolled were aged 2-71 months, a wider age range than the AAP guidelines currently encompass. [61]

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