Pediatric Pyelonephritis Medication
- Author: Patrick B Hinfey, MD; Chief Editor: Russell W Steele, MD more...
As previously stated, most cases of pyelonephritis respond readily to antibiotic treatment without further sequelae. Antibiotic therapy should be started after the urinalysis and culture have been performed, with the results of urine culture ultimately dictating the choice of antibiotics. A 7- to 14-day course of antibiotics is recommended. Special attention is needed when dosing antibiotics in neonates and in infants born prematurely.
Empiric antibiotics should be chosen to cover E coli and Enterococcus, Proteus, and Klebsiella species.
Cefixime is a third-generation cephalosporin with broad, gram-negative activity. The drug arrests cell-wall development. Tablets are no longer available in United States; a suspension is available from Lupin Pharmaceutical.
This is an aminoglycoside antibiotic for gram-negative coverage. Gentamicin is administered parenterally and may be coadministered with ampicillin.
Ceftriaxone is a third-generation cephalosporin with broad-spectrum, gram-negative activity; it has decreased efficacy against gram-positive organisms. Ceftriaxone arrests bacterial growth by binding to 1 or more penicillin-binding proteins.
Cefotaxime is a third-generation cephalosporin with a gram-negative spectrum; it has decreased efficacy against gram-positive organisms. Cefotaxime arrests bacterial cell ̶ wall synthesis.
TMP-SMZ inhibits bacterial growth by inhibiting the synthesis of dihydrofolic acid. It exerts antibacterial activity against common urinary tract pathogens.
This is an amino penicillin with a beta-lactamase inhibitor. It is for infants and children over age 3 months, base dosing on amoxicillin content. Because of different amoxicillin–clavulanic acid ratios in the 250-mg (250 mg/125 mg) versus 250-mg chewable tablet (250 mg/62.5 mg), do not use the 250-mg tablet until the child weighs more than 40 kg.
Amoxicillin interferes with the synthesis of cell-wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria.
Ampicillin has bactericidal activity against susceptible organisms. It is administered parenterally and is used in combination with gentamicin or cefotaxime. Ampicillin is an alternative to amoxicillin when patients are unable to take medication orally.
Ciprofloxacin is a fluoroquinolone that inhibits bacterial deoxyribonucleic acid (DNA) synthesis and, consequently, growth by inhibiting DNA gyrase and topoisomerases, which are required for replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Ciprofloxacin has no activity against anaerobes. Continue treatment for at least 2 days (7-14 d typical) after signs and symptoms have disappeared.
Montini G, Tullus K, Hewitt I. Febrile urinary tract infections in children. N Engl J Med. 2011 Jul 21. 365(3):239-50. [Medline].
Shaikh N, Ewing AL, Bhatnagar S, Hoberman A. Risk of renal scarring in children with a first urinary tract infection: a systematic review. Pediatrics. 2010 Dec. 126(6):1084-91. [Medline].
Lee YJ, Lee JH, Park YS. Risk factors for renal scar formation in infants with first episode of acute pyelonephritis: a prospective clinical study. J Urol. 2012 Mar. 187(3):1032-6. [Medline].
Özçakar ZB, Yalçinkaya F, Kavaz A, Kadioglu G, Elhan AH, Aysev D, et al. Urinary tract infections owing to ESBL-producing bacteria: microorganisms change--clinical pattern does not. Acta Paediatr. 2011 Aug. 100(8):e61-4. [Medline].
Lundstedt AC, Leijonhufvud I, Ragnarsdottir B, et al. Inherited susceptibility to acute pyelonephritis: a family study of urinary tract infection. J Infect Dis. 2007 Apr 15. 195(8):1227-34. [Medline].
Faust WC, Diaz M, Pohl HG. Incidence of post-pyelonephritic renal scarring: a meta-analysis of the dimercapto-succinic acid literature. J Urol. 2009 Jan. 181(1):290-7; discussion 297-8. [Medline].
Bhat RG, Katy TA, Place FC. Pediatric urinary tract infections. Emerg Med Clin North Am. 2011 Aug. 29(3):637-53. [Medline].
Gauthier M, Gouin S, Phan V, Gravel J. Association of malodorous urine with urinary tract infection in children aged 1 to 36 months. Pediatrics. 2012 May. 129(5):885-90. [Medline].
Williams GJ, Macaskill P, Chan SF, Turner RM, Hodson E, Craig JC. Absolute and relative accuracy of rapid urine tests for urinary tract infection in children: a meta-analysis. Lancet Infect Dis. 2010 Apr. 10(4):240-50. [Medline].
Lertdumrongluk K, Thongmee T, Kerr SJ, Theamboonlers A, Poovorawan Y, Rianthavorn P. Diagnostic accuracy of urine heparin binding protein for pediatric acute pyelonephritis. Eur J Pediatr. 2014 Jun 26. [Medline].
Pecile P, Romanello C. Procalcitonin and pyelonephritis in children. Curr Opin Infect Dis. 2007 Feb. 20(1):83-7. [Medline].
Leroy S, Fernandez-Lopez A, Nikfar R, Romanello C, Bouissou F, Gervaix A, et al. Association of Procalcitonin With Acute Pyelonephritis and Renal Scars in Pediatric UTI. Pediatrics. 2013 May. 131(5):870-9. [Medline].
Shaikh N, Borrell JL, Evron J, Leeflang MM. Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev. 2015 Jan 20. 1:CD009185. [Medline].
American Academy of Pediatrics. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics. 2011 Aug 28. [Medline].
Wang YT, Chiu NT, Chen MJ, et al. Correlation of renal ultrasonographic findings with inflammatory volume from dimercaptosuccinic acid renal scans in children with acute pyelonephritis. J Urol. 2005 Jan. 173(1):190-4; discussion 194. [Medline].
[Guideline] Subcommittee on Urinary Tract Infection; Steering Committe on Quality Improvement and Management. Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months. Pediatrics. 2011 Aug 28. [Medline].
Lee YJ, Lee JH, Park YS. Risk Factors for Renal Scar Formation in Infants With First Episode of Acute Pyelonephritis: A Prospective Clinical Study. J Urol. 2012 Jan 18. [Medline].
Kovanlikaya A, Okkay N, Cakmakci H, et al. Comparison of MRI and renal cortical scintigraphy findings in childhood acute pyelonephritis: preliminary experience. Eur J Radiol. 2004 Jan. 49(1):76-80. [Medline].
Kavanagh EC, Ryan S, Awan A, et al. Can MRI replace DMSA in the detection of renal parenchymal defects in children with urinary tract infections?. Pediatr Radiol. 2005 Mar. 35(3):275-81. [Medline].
Bocquet N, Sergent Alaoui A, Jais JP, Gajdos V, Guigonis V, Lacour B. Randomized trial of oral versus sequential IV/oral antibiotic for acute pyelonephritis in children. Pediatrics. 2012 Feb. 129(2):e269-75. [Medline].
Montini G, Rigon L, Zucchetta P, et al. Prophylaxis after first febrile urinary tract infection in children? A multicenter, randomized, controlled, noninferiority trial. Pediatrics. 2008 Nov. 122(5):1064-71. [Medline].
Williams G, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev. 2011 Mar 16. CD001534. [Medline].
Hodson EM, Willis NS, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev. 2007 Oct 17. CD003772. [Medline].
Williams GJ, Wei L, Lee A, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev. 2006 Jul 19. 3:CD001534. [Medline].
Garin EH, Olavarria F, Garcia Nieto V, et al. Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics. 2006 Mar. 117(3):626-32. [Medline].
Bloomfield P, Hodson EM, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev. 2005 Jan 25. CD003772. [Medline].
Huang YY, Chen MJ, Chiu NT, Chou HH, Lin KY, Chiou YY. Adjunctive Oral Methylprednisolone in Pediatric Acute Pyelonephritis Alleviates Renal Scarring. Pediatrics. 2011 Aug 15. [Medline].
La Scola C, De Mutiis C, Hewitt IK, Puccio G, Toffolo A, Zucchetta P, et al. Different Guidelines for Imaging After First UTI in Febrile Infants: Yield, Cost, and Radiation. Pediatrics. 2013 Mar. 131(3):e665-71. [Medline].
Finnell SM, Carroll AE, Downs SM. Technical report—Diagnosis and management of an initial UTI in febrile infants and young children. Pediatrics. 2011 Sep. 128(3):e749-70. [Medline].
Beetz R. Evaluation and management of urinary tract infections in the neonate. Curr Opin Pediatr. 2012 Apr. 24(2):205-11. [Medline].
Beetz R, Westenfelder M. Antimicrobial therapy of urinary tract infections in children. Int J Antimicrob Agents. 2011 Dec. 38 Suppl:42-50. [Medline].
Gil-Ruiz MA, Alcaraz AJ, Marañón RJ, Navarro N, Huidobro B, Luque A. Electrolyte disturbances in acute pyelonephritis. Pediatr Nephrol. 2012 Mar. 27(3):429-33. [Medline].
Hunziker M, Mohanan N, D'Asta F, Puri P. Incidence of febrile urinary tract infections in children after successful endoscopic treatment of vesicoureteral reflux: a long-term follow-up. J Pediatr. 2012 Jun. 160(6):1015-20. [Medline].
Lee JH, Kim MK, Park SE. Is a routine voiding cystourethrogram necessary in children after the first febrile urinary tract infection?. Acta Paediatr. 2012 Mar. 101(3):e105-9. [Medline].
Printza N, Farmaki E, Piretzi K, Arsos G, Kollios K, Papachristou F. Acute phase 99mTc-dimercaptosuccinic acid scan in infants with first episode of febrile urinary tract infection. World J Pediatr. 2012 Feb. 8(1):52-6. [Medline].
Santoro JD, Carroll VG, Steele RW. Diagnosis and management of urinary tract infections in neonates and young infants. Clin Pediatr (Phila). 2013 Feb. 52(2):111-4. [Medline].