From the Guidelines
Recommended Antibiotic Choice for UTI in Pediatric Patients
The first-line antibiotic choice for urinary tract infections (UTIs) in pediatric patients is typically amoxicillin/clavulanate or trimethoprim/sulfamethoxazole, depending on local resistance patterns and the child's specific situation 1.
- Amoxicillin/clavulanate is often recommended at a dose of 20-40 mg/kg per day divided into 3 doses for 7-14 days for uncomplicated UTIs 1.
- Alternatively, trimethoprim/sulfamethoxazole can be used at a dose of 6-12 mg/kg per day of the trimethoprim component, divided into 2 doses, for 7-14 days 1.
- For children with more complicated UTIs or those who cannot tolerate oral medications, intravenous ceftriaxone or cefotaxime may be considered, with doses adjusted according to the child's weight and renal function 1.
- It's essential to note that the choice of antibiotic should be guided by urine culture and sensitivity results when available, and the treatment duration may vary based on the severity of the infection and the child's response to therapy.
- Local patterns of susceptibility of coliforms to antimicrobial agents should also be taken into account during selection of an antimicrobial agent before sensitivity results are available 1.
- The total course of therapy should be 7 to 14 days, with the minimal duration selected being 7 days 1.
From the FDA Drug Label
Children: The recommended dose for children with urinary tract infections or acute otitis media is 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours for 10 days. The recommended antibiotic choice for Urinary Tract Infection (UTI) in pediatric patients is sulfamethoxazole and trimethoprim. The dose is 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours for 10 days 2 3.
- Key points:
- Not recommended for use in pediatric patients less than 2 months of age.
- The dose should be adjusted based on the patient's weight, using the provided table as a guideline.
From the Research
Recommended Antibiotic Choice for UTI in Pediatric Patients
The choice of antibiotic for urinary tract infections (UTIs) in pediatric patients depends on various factors, including the severity of the infection, the patient's age, and local resistance patterns.
- For neonates younger than 28 days with a febrile UTI, parenteral amoxicillin and cefotaxime are recommended 4.
- For infants from 28 days to 3 months who appear clinically ill with a febrile UTI, parenteral administration of a 3rd generation cephalosporin or gentamicin is recommended 4.
- For children with complicated pyelonephritis, parenteral ceftriaxone or gentamicin is recommended until clinically improved and without fever for 24 hours, followed by 10 to 14 days of oral antibiotic therapy 4.
- For children with uncomplicated pyelonephritis, parenteral ceftriaxone or gentamicin is recommended until without fever for 24 hours, followed by 10 to 14 days of oral antibiotic therapy 4.
- For children with cystitis who are moderately to severely symptomatic, an oral antibiotic such as amoxicillin-clavulanate or a second or third generation cephalosporin is recommended 5, 6.
- Nitrofurantoin is also a suitable option for uncomplicated cystitis in children over 1 month of age 7, 6.
- First generation cephalosporins are the preferred empiric antibiotics for febrile UTI in outpatient children 8.
Considerations for Antibiotic Resistance
- Local data on antibiotic resistance patterns should be considered when choosing an antibiotic 5, 8.
- Resistance rates to common oral antibiotics such as ampicillin/clavulanate and trimethoprim-sulfamethoxazole are increasing, and alternative options should be considered 7, 8.
- Urinary tract abnormalities and recurrent UTIs are associated with increased antibiotic resistance rates 8.