What is the treatment for pediatric urinary tract infections (UTIs)?

From the Guidelines

The treatment for pediatric urinary tract infections typically involves antibiotics, with the specific regimen depending on the child's age, infection severity, and local resistance patterns, and the most recent evidence supports the use of oral antibiotics such as amoxicillin-clavulanate, trimethoprim-sulfamethoxazole, or cephalexin for 7-10 days 1.

Key Considerations

• For uncomplicated UTIs, oral antibiotics are commonly prescribed, with options including:
  • Amoxicillin-clavulanate (20-40 mg/kg/day divided every 8 hours)
  • Trimethoprim-sulfamethoxazole (6-12 mg/kg/day of trimethoprim component divided every 12 hours)
  • Cephalexin (25-50 mg/kg/day divided every 6-8 hours)
• For infants under 3 months or children with pyelonephritis, febrile UTI, or systemic symptoms, initial intravenous antibiotics like ceftriaxone (50-75 mg/kg/day) may be necessary, followed by oral antibiotics once improvement occurs 1.
• Adequate hydration is essential during treatment to help flush bacteria from the urinary tract.
• Parents should ensure the child completes the full antibiotic course even if symptoms improve quickly, as premature discontinuation can lead to recurrence or resistant infections.

Preventive Measures

• Proper wiping techniques (front to back for girls)
• Regular urination
• Avoiding bubble baths
• Treating constipation if present, as these can help prevent recurrent infections by reducing bacterial colonization of the urinary tract 1.

Follow-up

• Follow-up urine cultures may be needed to confirm resolution, particularly in younger children or those with recurrent infections.
• The optimal timing for follow-up and the decision to perform repeat urine cultures should be individualized to each case and incorporate shared decision-making with the patient and caregivers 1.

From the FDA Drug Label

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. Cefixime for oral suspension and cefixime capsule is indicated in the treatment of adults and pediatric patients six months of age or older with uncomplicated urinary tract infections caused by susceptible isolates of Escherichia coli and Proteus mirabilis.

Treatment for Pediatric UTI:

• For pediatric patients 2 months of age or older, trimethoprim/sulfamethoxazole (PO) can be used at a dose of 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours for 10 days 2.
• For pediatric patients six months of age or older, cefixime (PO) can be used to treat uncomplicated urinary tract infections caused by susceptible isolates of Escherichia coli and Proteus mirabilis 3. Key Considerations:
• The choice of antibiotic and dosage should be based on the specific needs of the patient and the severity of the infection.
• It is essential to follow the recommended dosage and treatment duration to ensure effective treatment and minimize the risk of antibiotic resistance.

From the Research

Treatment Overview

• The treatment for pediatric urinary tract infections (UTIs) depends on the age of the child, the severity of the symptoms, and the presence of complicating factors 4, 5, 6, 7, 8.
• For neonates younger than 28 days with a febrile UTI, hospitalization and parenteral antibiotic therapy with amoxicillin and cefotaxime are recommended 4.
• For infants from 28 days to 3 months who appear clinically ill with a febrile UTI, hospitalization and parenteral administration of a 3rd generation cephalosporin or gentamicin are recommended 4.

Antibiotic Therapy

• Oral antibiotic therapy for 7 to 10 days is adequate for uncomplicated cases that respond well to the treatment 5.
• The choice of antibiotics should take into consideration local data on antibiotic resistance patterns 6, 7, 8.
• A second or third generation cephalosporin and amoxicillin-clavulanate are drugs of choice in the treatment of acute uncomplicated UTI 6.
• 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 6, 7.

Duration of Therapy

• The duration of therapy depends on the severity of the symptoms and the presence of complicating factors 4, 5, 6, 7.
• For uncomplicated pyelonephritis, 10 to 14 days of therapy with an oral antibiotic are recommended 4, 5.
• For cystitis, 5 to 7 days of treatment with an oral antibiotic are recommended if the therapy is effective 4.

Imaging Studies

• A renal ultrasound examination is advised in all young children with first febrile UTI and in older children with recurrent UTI 5.
• A voiding cystourethrogram 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 5.