Antibiotics

Class Summary

These are used for maintenance of sterile urine. Antibiotic agents used for prophylaxis in children with vesicoureteral reflux (VUR) are chosen for their efficacy in the urinary tract, safety, and tolerability. The typical dose is one fourth of the therapeutic dose. They are usually administered as suspensions once daily, typically in the evening to maximize overnight drug levels in the bladder. In neonates with antenatally diagnosed hydronephrosis and in infants younger than 8 weeks who have been treated for urinary tract infection (UTI), the agent of choice is amoxicillin. For older children, the most common antibiotics used are trimethoprim-sulfamethoxazole, nitrofurantoin, and penicillins. The cephalosporins are used less often.

Amoxicillin (Amoxil, Biomox, Trimox)

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Interferes with synthesis of cell wall mucopeptides during active multiplication, resulting in bactericidal activity against susceptible bacteria. Is generally well tolerated, although has a higher rate of fecal resistance than some other agents. Metabolized effectively by newborns, making it a good choice for neonates.

Sulfamethoxazole and trimethoprim (Bactrim, Septra, Cotrim)

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Inhibit bacterial growth by inhibiting synthesis of dihydrofolic acid. DOC in children >6-8 wk. The maturing hepatobiliary system is able to process trimethoprim-sulfamethoxazole combination agents, which have an excellent urinary concentration profile and tend to cause fewer fecal resistance problems. Well tolerated orally.

Nitrofurantoin (Furadantin, Macrodantin)

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Synthetic nitrofuran that interferes with bacterial carbohydrate metabolism by inhibiting acetylcoenzyme A. Bacteriostatic at low concentrations (5-10 mcg/mL) and bactericidal at higher concentrations.

Another common urinary antiseptic agent for children >8 wk. Unpleasant taste of the liquid form makes it unacceptable to some children. Older children who can tolerate tablets do well with this medication.

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Author

Caleb P Nelson, MD, MPH Assistant Professor of Surgery (Urology), Department of Urology, Harvard Medical School; Consulting Staff, Department of Urology, Children's Hospital Boston

Caleb P Nelson, MD, MPH is a member of the following medical societies: American Urological Association, Endourological Society, Phi Beta Kappa, Societies for Pediatric Urology, Society for Fetal Urology

Disclosure: Nothing to disclose.

Coauthor(s)

Harry P Koo, MD Chairman of Urology Division, Director of Pediatric Urology, Professor of Surgery, Virginia Commonwealth University School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond

Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Martin David Bomalaski, MD, FAAP Pediatric Urologist, Alaska Urology; Clinical Assistant Professor, Seattle Children's Hospital

Martin David Bomalaski, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Urological Association

Disclosure: Nothing to disclose.

Chief Editor

Marc Cendron, MD Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston

Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, New Hampshire Medical Society, Societies for Pediatric Urology, Society for Fetal Urology, Johns Hopkins Medical and Surgical Association, European Society for Paediatric Urology

Disclosure: Nothing to disclose.

Additional Contributors

Bartley G Cilento, Jr, MD Instructor, Department of Surgery, Division of Urology, Children's Hospital of Boston and Harvard Medical School

Bartley G Cilento, Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, Massachusetts Medical Society

Disclosure: Nothing to disclose.