Pediatric Urinary Tract Infection Empiric Therapy

Empiric therapeutic regimes for pediatric urinary tract infections are provided below based on patient age. ^{[1, 2, 3, 4, 5]}

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. ^[6]

Age < 2mo

See the list below:

• Cefotaxime 150 mg/kg/day IV/IM divided q6-8h

• Ceftriaxone 75 mg/kg/day IV/IM as a single dose or divided q12h (ceftriaxone should not be used in infants younger than 6wk) or

• Ampicillin 100 mg/kg/day IV/IM divided q8h plus gentamicin 3.5-5 mg/kg/dose IV q24h if patient younger than 7d, otherwise gentamicin 5-7.5 mg/kg/dose IV q24h

• Transition to oral antibiotic active against the offending organism after 24-48h for total of 14d course

Age 2mo to 18y

Outpatient therapy:

• Nitrofurantoin 5-7 mg/kg PO divided q6h for 3-10d or

  • Contraindicated in Children < 3 months of age or when GFR < 50% or in children with G6PD deficiency

  • Should not be used in children with symptoms consistent with pyelonephritis as it is poorly concentrated in the bloodstream and has poor tissue penetration or

• Trimethoprim (TMP) and sulfamethoxazole 6-12 mg/kg/day PO divided q12h, based on TMP component or

  • Contraindicated in children < 6 weeks of age

• Sulfisoxazole 120-150 mg/kg divided q 6h or

• Amoxicillin clavulanic acid - 20-40 mg/kg/day divided q8h or

• Cephalexin 50-100 mg/kg/day divided q6h or

• Cefixime 8 mg/kg/day q 24h or

• Cefpodoxime 10 mg/kg/day divided q 12h or

• Cefprozil 30 mg/kg/day divided q 12h or

• Cefuroxime axetil 20-30 mg/kg/day divided q12h

• Studies have shown oral antibiotics to be as effective as IV antibiotics in most cases of simple pediatric cystitis

• Most children may be treated with oral medications; those deemed “toxic” or are unable to retain oral intake may require parental treatment

• Short-course (3d or 5d) oral antibiotic therapy has been shown to be as effective as 10-d or 14-d courses for nonfebrile UTIs

• For febrile UTIs, the minimum treatment duration should be 7d and may extend to 10-14d

Inpatient therapy:

• Ceftriaxone 75 mg/kg/day IV/IM every 24h or

• Cefotaxime 150 mg/kg/day IV/IM divided q6-8h or

• Ceftazidime 100-150 mg/kg/day divided q8h or

• Ampicillin 100 mg/kg/day IV/IM divided q8h plus  gentamicin 7.5 mg/kg/day IV divided q8h or

• Tobramycin 5 mg/kg/day divided q8h or

• Piperacillin 300 mg/kg/day divided q 6-8h

• Ceftazidime/avibactam: Aged 3 months to < 2 years: 62.5 mg/kg (ceftazidime 50 mg/kg and avibactam 12.5 mg/kg) IV q8hr for 7-14 days

• Ceftazidime/avibactam: Aged 2-18 years: 62.5 mg/kg (ceftazidime 50 mg/kg and avibactam 12.5 mg/kg) IV q8hr for 7-14 days; not to exceed 2.5 grams (ceftazidime 2 grams and avibactam 0.5 grams)

• Transition to oral antibiotic active against the offending organism after 24-48h