What are the current guidelines for treating pediatric urinary tract infections (UTIs)?

From the Guidelines

The most current guidelines for treating pediatric urinary tract infections (UTIs) recommend oral antibiotics as first-line therapy for most uncomplicated cases, with empiric treatment regimens containing antimicrobials that have historically demonstrated efficacy and safety in the treatment of UTIs, such as nitrofurantoin, trimethoprim-sulfamethoxazole, or a first-generation cephalosporin, depending on local resistance rates 1. For febrile UTIs in infants and young children, a 7-10 day course of antibiotics is typically recommended, with common options including amoxicillin-clavulanate (40 mg/kg/day divided twice daily), cephalexin (50-100 mg/kg/day divided three to four times daily), or trimethoprim-sulfamethoxazole (8 mg/kg/day of trimethoprim component divided twice daily) 1. Some key points to consider when treating pediatric UTIs include:

• Empiric therapy should be adjusted based on local resistance patterns and culture results when available 1
• Children who appear toxic, cannot tolerate oral medications, or have complicated UTIs may require initial parenteral therapy, commonly with ceftriaxone (50-75 mg/kg/day) or gentamicin (5-7.5 mg/kg/day) 1
• Adequate hydration should be maintained throughout treatment
• Follow-up urine cultures are generally not needed if symptoms resolve, but imaging studies may be indicated for recurrent infections, especially in younger children, to identify anatomical abnormalities 1
• Antibiotic prophylaxis is no longer routinely recommended after a first UTI but may be considered for children with recurrent infections or significant vesicoureteral reflux 1 The approach to treating pediatric UTIs should prioritize minimizing antimicrobial resistance and unnecessary interventions while effectively managing the infection and preventing long-term complications 1.

From the FDA Drug Label

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.

The current guidelines for treating pediatric urinary tract infections (UTIs) with cefixime include:

• Uncomplicated UTIs: Cefixime is indicated for pediatric patients six months of age or older.
• Causative organisms: Susceptible isolates of Escherichia coli and Proteus mirabilis.
• Age range: Six months of age or older. 2

From the Research

Treatment Guidelines for Pediatric Urinary Tract Infections (UTIs)

• The treatment of pediatric UTIs depends on the age and clinical presentation of the child, as well as the severity of the infection 3, 4, 5.
• For neonates younger than 28 days with a febrile UTI, hospitalization and parenteral antibiotic therapy with amoxicillin and cefotaxime are recommended 3.
• Infants from 28 days to 3 months who appear clinically ill with a febrile UTI should be hospitalized and receive parenteral administration of a 3rd generation cephalosporin or gentamicin 3.
• Children with complicated pyelonephritis should be hospitalized and receive parenteral ceftriaxone or gentamicin until clinically improved and without fever for 24 hours, followed by 10 to 14 days of oral antibiotic therapy 3.
• Children with uncomplicated pyelonephritis should receive parenteral ceftriaxone or gentamicin until without fever for 24 hours, followed by 10 to 14 days of oral antibiotic therapy 3.
• Children with cystitis who are mildly symptomatic should be managed with supportive care until the result of the urine culture and sensitivity are available, while those who are moderately to severely symptomatic should receive an oral antibiotic and supportive care immediately 3.

Antibiotic Therapy

• The choice of antibiotics should take into consideration local data on antibiotic resistance patterns 6, 4.
• Amikacin is active against the majority of E-ESBL strains and could be prescribed as monotherapy for patients in pediatric emergency departments or otherwise hospitalized patients 6.
• A second or third generation cephalosporin and amoxicillin-clavulanate are drugs of choice in the treatment of acute uncomplicated UTI 4.
• 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 4.

Prevention of Recurrent UTIs

• The use of continuous antibiotic prophylaxis (CAP) is not recommended in children with a previous UTI, with recurrent UTIs, with vesicoureteral reflux (VUR) of any grade, with isolated hydronephrosis, and with neurogenic bladder 7.
• CAP is suggested in children with significant obstructive uropathies until surgical correction 7.
• Close surveillance based on early diagnosis of UTI episodes and prompt antibiotic therapy is proposed for conditions in which CAP is not recommended 7.