From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
For a 5-year-old with a painful penis, I recommend a systematic evaluation starting with a thorough history and physical examination to identify the underlying cause and guide appropriate treatment. The evaluation should include asking about onset, duration, associated symptoms like dysuria or discharge, recent trauma, hygiene practices, and any skin conditions. A careful examination of the penis is necessary to identify signs of balanitis (inflammation of the glans), phimosis (tight foreskin), paraphimosis (retracted foreskin that can't return to normal position), zipper injury, hair tourniquet, or signs of infection.
Key Considerations
- Urinalysis should be performed to rule out urinary tract infection, which may require antibiotics based on culture results 1, 2.
- For balanitis, treatment includes gentle cleansing with warm water and mild soap, followed by topical antifungal cream like clotrimazole 1% or antibacterial ointment like mupirocin 2% applied twice daily for 7-10 days.
- Phimosis may require gentle retraction during bathing and steroid cream (0.05% betamethasone) applied twice daily for 4-6 weeks.
- For paraphimosis, urgent manual reduction is needed, sometimes requiring procedural sedation.
- Zipper injuries require careful removal of entrapped skin, possibly with mineral oil application to help release the zipper.
- Hair tourniquets need immediate removal.
Pain Management and Follow-Up
Pain management with acetaminophen (15mg/kg/dose every 4-6 hours) is appropriate. Prompt urological consultation is necessary for severe cases or if symptoms don't improve within 48 hours of treatment. The choice of antibiotic for urinary tract infections should be guided by culture results and susceptibility patterns, with consideration of the increasing resistance patterns as noted in recent studies 1, 2.
Given the potential for antibiotic resistance, the use of amoxicillin-clavulanate as an oral therapy option for urinary tract infections caused by extended-spectrum beta-lactamase-producing Escherichia coli is supported by recent evidence 2, highlighting the importance of susceptibility testing to guide antibiotic therapy.