Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Pediatric Urinary Tract Infection Medication

  • Author: Donna J Fisher, MD; Chief Editor: Russell W Steele, MD  more...
 
Updated: Jun 18, 2015
 

Medication Summary

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.

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.[58]

Next

Antibiotics, Other

Class Summary

Antibiotics are used to treat bacterial infections of the urinary tract. Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Ceftriaxone (Rocephin)

 

This third-generation cephalosporin is used for initial parenteral therapy for complicated pyelonephritis in pediatric patients beyond the neonatal period. It is indicated for urinary tract infections caused by E coli, Proteus mirabilis, Morganella morganii, P vulgaris, or K pneumoniae.

Cefotaxime (Claforan)

 

Cefotaxime is a third-generation cephalosporin that is used as initial parenteral therapy for pediatric patients with acute complicated pyelonephritis. It may be used in neonates or jaundiced patients. Dosing every 6-8 hours is required. In infants, a 2- to 8-week regimen also includes ampicillin.

Ampicillin (Marcillin, Omnipen, Polycillin)

 

Ampicillin is a parenteral agent used for initial treatment of patients with acute pyelonephritis who have gram-positive cocci in urinary sediment or in whom no organisms are observed in the urine. It is indicated for UTIs caused by E coli and P mirabilis.

Amoxicillin and clavulanate (Augmentin, Amoclan)

 

This is an oral therapy for infection with susceptible organisms. Amoxicillin inhibits bacterial cell-wall synthesis by binding to penicillin-binding proteins. The addition of clavulanate inhibits beta-lactamase ̶ producing bacteria.

This is a good alternative antibiotic for patients who are allergic to or intolerant of the macrolide class. It is usually well tolerated and is effective against most infectious agents, although it is not effective against Mycoplasma and Legionella species. It has good tissue penetration but does not enter the cerebrospinal fluid (CSF).

For patients over age 3 months, base dosing protocol on amoxicillin content. Because of different amoxicillin/clavulanic acid ratios in the 250-mg tablet (250/125) versus the 250-mg chewable tablet (250/62.5), do not use the 250-mg tablet until the child weighs over 40 kg. The amoxicillin-clavulanate combination is also available as an oral suspension for children. The half-life of the oral form is 1-1.3 hours.

Gentamicin

 

This aminoglycoside is used for initial parenteral therapy in patients with bacterial pyelonephritis who are allergic to cephalosporins. For complicated UTI, it is sometimes used in combination with a cephalosporin.

Sulfamethoxazole and trimethoprim (Bactrim, Cotrim, Septra)

 

This is an oral treatment for bacterial UTI and for prevention of reinfection. It is available as an oral tablet or a suspension.

Cephalexin (Keflex)

 

Cephalexin is a first-generation cephalosporin. This is an oral treatment for bacterial UTI and for prevention of infection in infants younger than 6-8 weeks.

Cefixime (Suprax)

 

Cefixime is a third-generation cephalosporin used for oral treatment of acute bacterial UTI. By binding to 1 or more penicillin-binding proteins, it arrests bacterial cell-wall synthesis and inhibits bacterial growth.

Cefpodoxime

 

Cefpodoxime is a third-generation cephalosporin used for oral treatment of acute bacterial UTI. It is indicated for the management of infections caused by susceptible mixed aerobic-anaerobic microorganisms.

Nitrofurantoin (Furadantin, Macrobid, Macrodantin)

 

This is an oral treatment for bacterial infections of the lower urinary tract (cystitis) and for the prevention of reinfection. Nitrofurantoin is a synthetic nitrofuran that interferes with bacterial carbohydrate metabolism by inhibiting acetylcoenzyme A. It is bacteriostatic at low concentrations (5-10 mcg/mL) and is bactericidal at higher concentrations.

Trimethoprim (Primsol)

 

Trimethoprim is an oral antibiotic used for the prevention of urinary tract infection. It is a dihydrofolate reductase inhibitor that prevents the production of tetrahydrofolic acid in bacteria. It is active in vitro against a broad range of gram-positive and gram-negative bacteria, including uropathogens (eg, Enterobacteriaceae and Staphylococcus saprophyticus).

Resistance is usually mediated by decreased cell permeability or by alterations in the structure or amount of dihydrofolate reductase. Trimethoprim demonstrates synergy with sulfonamides, potentiating inhibition of bacterial tetrahydrofolate production.

Ciprofloxacin (Cipro, Cipro XR)

 

This agent is a fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth by inhibiting DNA gyrase and topoisomerases, enzymes that are required for the 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 days typical) after signs and symptoms have disappeared.

This agent is not a drug of first choice in pediatric patients, because of an increased incidence of adverse events, including arthropathy, compared with controls. No data exist for dose adjustments for pediatric patients with renal impairment.

Tobramycin

 

Tobramycin may be an option for the empiric parenteral treatment of UTI. It is used in skin, bone, and skin-structure infections caused by Staphylococcus aureus, Pseudomonas aeruginosa, and E coli, as well as by Klebsiella, Proteus, and Enterobacter species.

This agent is indicated in the treatment of staphylococcal infections when penicillin or potentially less toxic drugs are contraindicated and when bacterial susceptibility and clinical judgment justify its use. Dosing regimens are numerous and are adjusted on the basis of creatinine clearance (CrCl) and changes in the volume of distribution.

Previous
Next

Analgesics, Other

Class Summary

These agents are used to provide relief from voiding symptoms caused by UTIs.

Acetaminophen (Tylenol, Mapap, Cetafen, Acephen)

 

Acetaminophen is a nonopioid systemic analgesic used for moderate voiding discomfort caused by UTI.

Ibuprofen (Motrin, Advil, Caldolor, Ibu, Addaprin)

 

Ibuprofen is a nonsteroidal anti-inflammatory agent that is used to provide symptomatic relief of dysuria.

Previous
Next

Analgesics, Urinary

Class Summary

These agents are used to relieve burning, spasticity, and pain during voiding caused by UTIs.

Phenazopyridine (Azo-Standard, Pyridium, Baridium)

 

Phenazopyridine exerts local topical anesthetic or analgesic action on urinary mucosa. It is used for symptomatic relief of pain, burning, urgency, frequency, and other discomforts arising from irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, endoscopic procedures, passage of sounds, or catheters. Its analgesic action may reduce or eliminate the need for systemic analgesics. When used concomitantly with antibiotics for UTI, phenazopyridine should not be used for longer than 2 days.

Previous
 
Contributor Information and Disclosures
Author

Donna J Fisher, MD Assistant Professor of Pediatrics, Tufts University School of Medicine; Chief, Division of Pediatric Infectious Diseases, Baystate Children's Hospital

Donna J Fisher, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Healthcare Epidemiology of America, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Leslie L Barton, MD Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Ann G Egland, MD Consulting Staff, Department of Operational and Emergency Medicine, Walter Reed Army Medical Center

Ann G Egland, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Association of Military Surgeons of the US, Medical Society of Virginia, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Terrance K Egland, MD Director, Business Planning and Development, Bureau of Medicine and Surgery

Disclosure: Nothing to disclose.

Stanley Hellerstein, MD (Retired) Pediatric Nephrologist, Children's Mercy Hospital of Kansas City; (Retired) Ernest L Glasscock, MD Chair in Pediatric Research, Professor of Pediatrics, University of Missouri School of Medicine at Kansas City

Disclosure: Nothing to disclose.

David S Howes, MD Professor of Medicine and Pediatrics, Section Chief and Emergency Medicine Residency Program Director, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

David S Howes, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Stephen L Thornton, MD Assistant Professor of Emergency Medicine, University of Kansas Hospital

Stephen L Thornton, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

References
  1. Henderson D. Abnormal Scan After UTI Raises Kids' Risk for Renal Scarring. Medscape Medical News. Aug 4 2014. [Full Text].

  2. Shaikh N, Craig JC, Rovers MM, et al. Identification of Children and Adolescents at Risk for Renal Scarring After a First Urinary Tract Infection: A Meta-analysis With Individual Patient Data. JAMA Pediatr. 2014 Aug 4. [Medline].

  3. [Guideline] Subcommittee on Urinary Tract Infection; Steering Committee 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].

  4. 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].

  5. Zaffanello M, Malerba G, Cataldi L, Antoniazzi F, Franchini M, Monti E, et al. Genetic risk for recurrent urinary tract infections in humans: a systematic review. J Biomed Biotechnol. 2010. 2010:321082. [Medline]. [Full Text].

  6. Schoen EJ, Colby CJ, Ray GT. Newborn circumcision decreases incidence and costs of urinary tract infections during the first year of life. Pediatrics. 2000 Apr. 105(4 Pt 1):789-93. [Medline].

  7. Shaikh N, Morone NE, Bost JE, Farrell MH. Prevalence of urinary tract infection in childhood: a meta-analysis. Pediatr Infect Dis J. 2008 Apr. 27(4):302-8. [Medline].

  8. Hoberman A, Chao HP, Keller DM, Hickey R, Davis HW, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr. 1993 Jul. 123(1):17-23. [Medline].

  9. Downs SM. Technical report: urinary tract infections in febrile infants and young children. The Urinary Tract Subcommittee of the American Academy of Pediatrics Committee on Quality Improvement. Pediatrics. 1999 Apr. 103(4):e54. [Medline].

  10. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD. U.S. renal data system, USRDS 2005 (2005) Annual data report: Atlas of end-stage renal disease in the United States. Available at http://www.usrds.org/atlas05.aspx. Accessed: July 29, 2013.

  11. Harambat J, van Stralen KJ, Kim JJ, Tizard EJ. Epidemiology of chronic kidney disease in children. Pediatr Nephrol. 2012 Mar. 27(3):363-73. [Medline]. [Full Text].

  12. Zorc JJ, Levine DA, Platt SL, Dayan PS, Macias CG, Krief W, et al. Clinical and demographic factors associated with urinary tract infection in young febrile infants. Pediatrics. 2005 Sep. 116(3):644-8. [Medline].

  13. Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, et al. Does this child have a urinary tract infection?. JAMA. 2007 Dec 26. 298(24):2895-904. [Medline].

  14. [Guideline] Committee on Quality Improvement, Subcommittee on Urinary Tract Infection, American Academy of Pediatrics. Practice Parameter: The Diagnosis, Treatment, and Evaluation of the Initial Urinary Tract Infection in Febrile Infants and Young Children. Available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/4/843. Accessed: July 30, 2013.

  15. Prentiss KA, Newby PK, Vinci RJ. Adolescent female with urinary symptoms: a diagnostic challenge for the pediatrician. Pediatr Emerg Care. 2011 Sep. 27(9):789-94. [Medline].

  16. Schroeder AR, Chang PW, Shen MW, Biondi EA, Greenhow TL. Diagnostic accuracy of the urinalysis for urinary tract infection in infants <3 months of age. Pediatrics. 2015 Jun. 135 (6):965-71. [Medline].

  17. Laidman J. Dipstick Test Effective Initial Screen for UTI in Infants. Medscape Medical News. May 1 2014. [Full Text].

  18. Glissmeyer EW, Korgenski EK, Wilkes J, et al. Dipstick screening for urinary tract infection in febrile infants. Pediatrics. 2014 Apr 28. [Medline].

  19. Girardet P, Frutiger P, Lang R. Urinary tract infections in pediatric practice. A comparative study of three diagnostic tools: dip-slides, bacterioscopy and leucocyturia. Paediatrician. 1980. 9(5-6):322-37. [Medline].

  20. Goldsmith BM, Campos JM. Comparison of urine dipstick, microscopy, and culture for the detection of bacteriuria in children. Clin Pediatr (Phila). 1990 Apr. 29(4):214-8. [Medline].

  21. Anderson JD, Chambers GK, Johnson HW. Application of a leukocyte and nitrite urine test strip to the management of children with neurogenic bladder. Diagn Microbiol Infect Dis. 1993 Jul. 17(1):29-33. [Medline].

  22. Craver RD, Abermanis JG. Dipstick only urinalysis screen for the pediatric emergency room. Pediatr Nephrol. 1997 Jun. 11(3):331-3. [Medline].

  23. Shaw KN, McGowan KL, Gorelick MH, Schwartz JS. Screening for urinary tract infection in infants in the emergency department: which test is best?. Pediatrics. 1998 Jun. 101(6):E1. [Medline].

  24. Anad FY. A simple method for selecting urine samples that need culturing. Ann Saudi Med. 2001 Jan-Mar. 21(1-2):104-5. [Medline].

  25. Bachur R, Harper MB. Reliability of the urinalysis for predicting urinary tract infections in young febrile children. Arch Pediatr Adolesc Med. 2001 Jan. 155(1):60-5. [Medline].

  26. Michael M, Hodson EM, Craig JC, Martin S, Moyer VA. Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children. Cochrane Database Syst Rev. 2003. CD003966. [Medline].

  27. Lunn A, Holden S, Boswell T, Watson AR. Automated microscopy, dipsticks and the diagnosis of urinary tract infection. Arch Dis Child. 2010 Mar. 95(3):193-7. [Medline].

  28. Smolkin V, Koren A, Raz R, Colodner R, Sakran W, Halevy R. Procalcitonin as a marker of acute pyelonephritis in infants and children. Pediatr Nephrol. 2002 Jun. 17(6):409-12. [Medline].

  29. Nikfar R, Khotaee G, Ataee N, Shams S. Usefulness of procalcitonin rapid test for the diagnosis of acute pyelonephritis in children in the emergency department. Pediatr Int. 2009 Jul 6. [Medline].

  30. Bressan S, Andreola B, Zucchetta P, Montini G, Burei M, Perilongo G, et al. Procalcitonin as a predictor of renal scarring in infants and young children. Pediatr Nephrol. 2009 Jun. 24(6):1199-204. [Medline].

  31. Wan J, Skoog SJ, Hulbert WC, Casale AJ, Greenfield SP, Cheng EY, et al. Section on Urology response to new Guidelines for the diagnosis and management of UTI. Pediatrics. 2012 Apr. 129(4):e1051-3. [Medline].

  32. Quigley R. Diagnosis of urinary tract infections in children. Curr Opin Pediatr. 2009 Apr. 21(2):194-8. [Medline].

  33. Lin DS, Huang FY, Chiu NC, Koa HA, Hung HY, Hsu CH, et al. Comparison of hemocytometer leukocyte counts and standard urinalyses for predicting urinary tract infections in febrile infants. Pediatr Infect Dis J. 2000 Mar. 19(3):223-7. [Medline].

  34. Lin DS, Huang SH, Lin CC, Tung YC, Huang TT, Chiu NC, et al. Urinary tract infection in febrile infants younger than eight weeks of Age. Pediatrics. 2000 Feb. 105(2):E20. [Medline].

  35. Kazi BA, Buffone GJ, Revell PA, Chandramohan L, Dowlin MD, Cruz AT. Performance characteristics of urinalyses for the diagnosis of pediatric urinary tract infection. Am J Emerg Med. 2013 Sep. 31(9):1405-7. [Medline].

  36. Reuters Health. Point-Of-Care Urinalysis Lacks Accuracy in Pediatric UTIs. Medscape [serial online]. Available at http://www.medscape.com/viewarticle/809965. Accessed: September 30, 2013.

  37. Tseng MH, Lin WJ, Lo WT, Wang SR, Chu ML, Wang CC. Does a normal DMSA obviate the performance of voiding cystourethrography in evaluation of young children after their first urinary tract infection?. J Pediatr. 2007 Jan. 150(1):96-9. [Medline].

  38. Merguerian PA, Sverrisson EF, Herz DB, McQuiston LT. Urinary tract infections in children: recommendations for antibiotic prophylaxis and evaluation. An evidence-based approach. Curr Urol Rep. 2010 Mar. 11(2):98-108. [Medline].

  39. Carpenter MA, Hoberman A, Mattoo TK, Mathews R, Keren R, Chesney RW, et al. The RIVUR Trial: Profile and Baseline Clinical Associations of Children With Vesicoureteral Reflux. Pediatrics. 2013 Jul. 132(1):e34-45. [Medline]. [Full Text].

  40. Spencer JD, Bates CM, Mahan JD, Niland ML, Staker SR, Hains DS, et al. The accuracy and health risks of a voiding cystourethrogram after a febrile urinary tract infection. J Pediatr Urol. 2012 Feb. 8(1):72-6. [Medline].

  41. McDonald A, Scranton M, Gillespie R, Mahajan V, Edwards GA. Voiding cystourethrograms and urinary tract infections: how long to wait?. Pediatrics. 2000 Apr. 105(4):E50. [Medline].

  42. Mahant S, To T, Friedman J. Timing of voiding cystourethrogram in the investigation of urinary tract infections in children. J Pediatr. 2001 Oct. 139(4):568-71. [Medline].

  43. Paschke AA, Zaoutis T, Conway PH, Xie D, Keren R. Previous antimicrobial exposure is associated with drug-resistant urinary tract infections in children. Pediatrics. 2010 Apr. 125(4):664-72. [Medline].

  44. Hodson EM, Willis NS, Craig JC. Antibiotics for acute pyelonephritis in children. Cochrane Database Syst Rev. 2007 Oct 17. CD003772. [Medline].

  45. Hoberman A, Wald ER, Hickey RW, Baskin M, Charron M, Majd M, et al. Oral versus initial intravenous therapy for urinary tract infections in young febrile children. Pediatrics. 1999 Jul. 104(1 Pt 1):79-86. [Medline].

  46. Schnadower D, Kuppermann N, Macias CG, et al. Febrile infants with urinary tract infections at very low risk for adverse events and bacteremia. Pediatrics. 2010 Dec. 126(6):1074-83. [Medline].

  47. Weisz D, Seabrook JA, Lim RK. The Presence of Urinary Nitrites Is a Significant Predictor of Pediatric Urinary Tract Infection Susceptibility to First- and Third-Generation Cephalosporins. J Emerg Med. Jul 2010. 39(1):6-12.

  48. Hoberman A, Keren R. Antimicrobial prophylaxis for urinary tract infection in children. N Engl J Med. 2009 Oct 29. 361(18):1804-6. [Medline].

  49. Montini G, Rigon L, Zucchetta P, Fregonese F, Toffolo A, Gobber D, 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].

  50. Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L. 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].

  51. Pennesi M, Travan L, Peratoner L, Bordugo A, Cattaneo A, Ronfani L, et al. Is antibiotic prophylaxis in children with vesicoureteral reflux effective in preventing pyelonephritis and renal scars? A randomized, controlled trial. Pediatrics. 2008 Jun. 121(6):e1489-94. [Medline].

  52. Mattoo TK. Are prophylactic antibiotics indicated after a urinary tract infection?. Curr Opin Pediatr. 2009 Apr. 21(2):203-6. [Medline]. [Full Text].

  53. Craig JC, Simpson JM, Williams GJ, Lowe A, Reynolds GJ, McTaggart SJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N Engl J Med. 2009 Oct 29. 361(18):1748-59. [Medline].

  54. Williams G, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev. 2011 Mar 16. 3:CD001534. [Medline].

  55. American Academy of Pediatrics Task Force on Circumcision. Circumcision policy statement. Pediatrics. 2012 Sep. 130(3):585-6. [Medline].

  56. Ferrara P, Romaniello L, Vitelli O, Gatto A, Serva M, Cataldi L. Cranberry juice for the prevention of recurrent urinary tract infections: a randomized controlled trial in children. Scand J Urol Nephrol. 2009. 43(5):369-72. [Medline].

  57. Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2012 Oct 17. 10:CD001321. [Medline].

  58. The RIVUR Trial Investigators. Antimicrobial Prophylaxis for Children with Vesicoureteral Reflux. N Engl J Med. 2014 May 4. [Medline].

 
Previous
Next
 
Application of low-risk criteria for and approach to the febrile infant: A reasonable approach for treating febrile infants younger than 2 months who have a temperature of greater than 38°C.
Table 1. Urinalysis for Presumptive Diagnosis of Urinary Tract Infection*
Method Findings
Bright-field or phase-contrast microscopy of centrifuged urinary sediment Bacteria
Gram stain of uncentrifuged or centrifuged urinary sediment Bacteria
Nitrite and leukocyte esterase test Positive = UTI likely
Nitrite test Positive = UTI probable
Leukocyte esterase test Positive = UTI probable
*Negative microscopic findings for bacteria do not rule out a UTI, nor do negative results of dipstick testing for nitrite and leukocyte esterase. False-negative nitrite readings are especially common in children.
Table 2. Quantitative Urine Culture for the Diagnosis of Urinary Tract Infection*
Method Finding
Suprapubic aspiration If a UTI is present, bacteria are likely to be proliferating in bladder urine with growth of any organism except 2000-3000 CFU/mL coagulase-negative staphylococci.
Catheterization in a girl or midstream, clean-void collection in a circumcised boy Febrile infants and children with UTI usually have >50,000 CFU/mL of a single urinary pathogen; however, UTI may be present with 10,000-50,000 CFU/mL of a single organism.*
Midstream, clean-void collection in a girl or uncircumcised boy UTI is indicated when >100,000 CFU/mL of a single urinary pathogen is present in a symptomatic patient. Pyuria usually present. A UTI may be present with 10,000-50,000 CFU/mL of a single bacterium.*
Any method in a girl or boy If the patient is asymptomatic, bacterial growth is usually >100,000 CFU/mL of the same organism on different days. If pyuria is absent, this result probably indicates colonization rather than infection.
*Patients with urinary frequency (ie, decreased bladder incubation time) are those most likely to have bacteria proliferating in the urinary bladder in the presence of low colony counts.
Table 3. Antibiotic Agents for Parenteral Treatment of a Urinary Tract Infection
Drug Dosage and Route Comment
Ceftriaxone 50-75 mg/kg/day IV/IM as a single dose or divided q12h Do not use in infants < 6 wk of age; parenteral antibiotic with long half-life; may displace bilirubin from albumin
Cefotaxime 150 mg/kg/day IV/IM divided q6-8h Safe to use in infants < 6 wk of age; used with ampicillin in infants aged 2-8 wk
Ampicillin 100 mg/kg/day IV/IM divided q8h Used with gentamicin in neonates < 2 wk of age; for enterococci and patients allergic to cephalosporins
Gentamicin Term neonates < 7 days: 3.5-5 mg/kg/dose IV q24h



Infants and children < 5 years: 2.5 mg/kg/dose IV q8h or single daily dosing with normal renal function of 5-7.5 mg/kg/dose IV q24h



Children ≥5 y: 2-2.5 mg/kg/dose IV q8h or single daily dosing with normal renal function of 5-7.5 mg/kg/dose IV q24h



Monitor blood levels and kidney function if therapy extends >48 h
Note: IM = intramuscular; IV = intravenous; q = every.
Table 4. Antibiotic Agents for the Oral Treatment of Urinary Tract Infection
Protocol Daily Dosage
Sulfamethoxazole and trimethoprim (SMZ-TMP) 30-60 mg/kg SMZ, 6-12 mg/kg TMP divided q12h
Amoxicillin and clavulanic acid 20-40 mg/kg divided q8h
Cephalexin 50-100 mg/kg divided q6h
Cefixime 8 mg/kg q24h
Cefpodoxime 10 mg/kg divided q12h
Nitrofurantoin* 5-7 mg/kg divided q6h
*Nitrofurantoin may be used to treat cystitis. It is not suitable for the treatment of pyelonephritis, because of its limited tissue penetration.
Table 5. Antibiotic Agents to Prevent Reinfection
Agent Single Daily Dose
Nitrofurantoin * 1-2 mg/kg PO
Sulfamethoxazole and trimethoprim (SMZ-TMP) * 5-10 mg/kg SMZ, 1-2 mg/kg TMP PO
Trimethoprim 1-2 mg/kg PO
*Do not use nitrofurantoin or sulfa drugs in infants younger than 6 weeks. Reduced doses of an oral first-generation cephalosporin, such as cephalexin at 10 mg/kg, may be used until the child reaches age 6 weeks. Ampicillin or amoxicillin are not recommended because of the high incidence of resistant E coli.
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.