What are the recommended antibiotics for pediatric urinary tract infections (UTI)?

From the Guidelines

For pediatric patients with a urinary tract infection (UTI), the recommended antibiotic treatment is amoxicillin-clavulanate 20–40 mg/kg per day in 3 doses, or a cephalosporin such as cefixime 8 mg/kg per day in 1 dose, with the total course of therapy being 7 to 14 days 1. The choice of antibiotic should be based on local patterns of susceptibility of coliforms to antimicrobial agents, particularly trimethoprim-sulfamethoxazole and cephalexin, due to substantial geographic variability 1. Some key points to consider when treating UTIs in pediatric patients include:

• The importance of completing the full course of antibiotics, even if symptoms improve quickly, to ensure the infection is fully cleared 1.
• The need to drink plenty of water during treatment to help flush bacteria from the system.
• Monitoring for signs of worsening symptoms, such as fever, back pain, or vomiting, which could indicate the infection has spread to the kidneys.
• Considering parenteral administration of an antimicrobial agent if the patient is too ill to take oral medication or if compliance is uncertain 1. It's also important to note that some antibiotics, such as nitrofurantoin, should not be used to treat febrile infants with UTIs due to insufficient serum antimicrobial concentrations 1. In terms of specific dosage and administration, the following options are recommended:
• Amoxicillin-clavulanate: 20–40 mg/kg per day in 3 doses 1.
• Cefixime: 8 mg/kg per day in 1 dose 1.
• Cefpodoxime: 10 mg/kg per day in 2 doses 1.
• Cefprozil: 30 mg/kg per day in 2 doses 1.
• Cefuroxime axetil: 20–30 mg/kg per day in 2 doses 1.
• Cephalexin: 50–100 mg/kg per day in 4 doses 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 following table is a guideline for the attainment of this dosage: Children 2 months of age or older: Weight Dose – every 12 hours lb kg Tablets 22 10 - 44 20 1 66 30 1½ 88 40 2 or 1 DS tablet

The recommended dosage of sulfamethoxazole and trimethoprim for pediatric patients with UTI 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.

• The dosage is based on the child's weight, with the following guidelines:
  • 22-44 lb (10-20 kg): 1 tablet every 12 hours
  • 66 lb (30 kg): 1½ tablets every 12 hours
  • 88 lb (40 kg): 2 tablets or 1 DS tablet every 12 hours

From the Research

Pediatric Antibiotics for UTI

• The treatment of urinary tract infections (UTIs) in pediatric patients involves the use of antibiotics, with the choice of antibiotic depending on the severity of the infection and the patient's age 3.
• For neonates younger than 28 days with a febrile UTI, hospitalization and treatment with parenteral amoxicillin and cefotaxime are recommended, followed by outpatient treatment with an oral antibiotic to complete 14 days of therapy 3.
• Infants from 28 days to 3 months who appear clinically ill with a febrile UTI should be hospitalized and treated with a 3rd generation cephalosporin or gentamicin, while those who are not acutely ill may be managed as outpatients with parenteral ceftriaxone or gentamicin 3.
• Children with complicated pyelonephritis should be hospitalized and treated with parenteral ceftriaxone or gentamicin, while those with uncomplicated pyelonephritis may be treated as outpatients with oral antibiotics 3.
• The use of amikacin as an initial treatment for febrile urinary tract infections is favored due to its activity against E-ESBL strains 4.

Antibiotic Resistance

• The proportion of Escherichia coli strains resistant to extended-spectrum ß-lactamases (E-ESBL) has remained stable over the last ten years, but the use of oral antibiotics is often limited due to resistance 4.
• The treatment of UTIs caused by antibiotic-resistant Gram-negative bacteria is a growing concern, with limited treatment options available 5.
• The use of new antimicrobials, such as ceftazidime-avibactam and meropenem/vaborbactam, may be effective in treating UTIs caused by multidrug-resistant organisms 5.

Prevention of Recurrent UTIs

• Antibiotic prophylaxis may be effective in preventing further episodes of UTI in children with a history of recurrent UTIs 6.
• Nitrofurantoin and cranberry products may be effective in reducing the incidence of symptomatic UTI episodes in pediatric patients with a history of RUTI 6.
• Further research is needed to determine the best prophylaxis options for preventing UTI recurrence and kidney scarring in children 6.