From the Guidelines
For a 2-year-old girl with febrile UTI, the recommended treatment is oral antibiotics for 7-14 days, starting with amoxicillin-clavulanate (40 mg/kg/day divided into two doses) or cefixime (8 mg/kg/day in one or two doses) 1. The choice of antibiotic should be based on the local patterns of susceptibility of coliforms to antimicrobial agents, particularly trimethoprim-sulfamethoxazole and cephalexin, due to substantial geographic variability 1. If the child is very ill or unable to tolerate oral medication, beginning with intravenous antibiotics such as ceftriaxone (50-75 mg/kg/day) for 24-48 hours, then switching to oral antibiotics once improved, is a suitable alternative 1. Some key points to consider in the treatment of febrile UTI in children include:
- Ensuring adequate hydration to help flush out bacteria
- Using acetaminophen or ibuprofen for fever and discomfort management
- Monitoring urine output and fever resolution
- Recommending a follow-up urine culture after treatment to ensure the infection has cleared This approach targets common uropathogens while considering the child's age and ability to take oral medication, aiming to reduce the risk of renal scarring and recurrence 1. It's also important to note that the effectiveness of current management of UTIs is put into question, and the role of imaging is to guide treatment by identifying patients who are at high risk to develop recurrent UTIs or renal scarring 1. However, the most recent and highest quality study 1 does not provide new evidence to change the current treatment approach, so the recommendation remains the same.
From the Research
Treatment for Febrile Urinary Tract Infection (UTI) in a 2-year-old Female
- The treatment for febrile UTI in children typically involves oral antibiotic therapy for 7 to 10 days 2.
- Empirical oral treatment with nitrofurantoin or nalidixic acid can safely be started in children with febrile UTI 3.
- For febrile UTI, the expert group recommended favoring initial treatment with aminoglycosides, such as amikacin, which remain active in the majority of ESBL strains 4.
- Ceftriaxone (IV or IM) remains an appropriate treatment for patients seen in the emergency department or outpatient clinic because the percentage of ESBL-producing enterobacteria strains remains low 4.
- Oral cefixime can be used in non-severe cases and low-risk patients defined as age > 3 months, general condition preserved, disease duration of fever < 4 days, no associated comorbidity, and no history of urinary tract infection, uropathy, or prior antibiotic therapy in the last 3 months 4.
- The total duration of treatment recommended is usually 10 days 4, 5.
- Parenteral antibiotic therapy is recommended for infants ≤ 2 months and any child who is toxic-looking, hemodynamically unstable, immunocompromised, unable to tolerate oral medication, or not responding to oral medication 5, 6.
- A combination of intravenous ampicillin and intravenous/intramuscular gentamycin or a third-generation cephalosporin can be used in those situations 5, 6.
Antibiotic Choices
- Currently, a second or third generation cephalosporin and amoxicillin-clavulanate are drugs of choice in the treatment of acute uncomplicated UTI 5.
- The choice of antibiotics should take into consideration local data on antibiotic resistance patterns 5.
- Escherichia coli susceptibility to nitrofurantoin, nalidixic acid, and cephalexin did not present any statistically significant differences over time 3.
Additional Recommendations
- A renal ultrasound examination is advised in all young children with first febrile UTI and in older children with recurrent UTI 2.
- Most children with first febrile UTI do not need a voiding cystourethrogram; it may be considered after the first UTI in children with abnormal renal and bladder ultrasound examination or a UTI caused by atypical pathogen, complex clinical course, or known renal scarring 2.
- Long-term antibiotic prophylaxis is used selectively in high-risk patients 2, 5.