What is the treatment for Urinary Tract Infection (UTI) in pediatrics?

From the Guidelines

For pediatric UTI treatment, antibiotics are the primary approach, with the most recent guidelines recommending oral antibiotics like amoxicillin-clavulanate, cephalexin, or trimethoprim-sulfamethoxazole for 7-10 days for uncomplicated UTIs 1.

Treatment Approach

The treatment of urinary tract infections (UTIs) in pediatrics focuses on curing the infection, preventing recurrence, and minimizing the risk of long-term sequelae such as renal scarring.

• For uncomplicated UTIs, oral antibiotics are typically prescribed.
• The choice of antibiotic may depend on the susceptibility of the causative organism and local resistance patterns.
• Initial parenteral therapy may be necessary for infants under 3 months or children with pyelonephritis, with options including ceftriaxone or ampicillin plus gentamicin, followed by oral antibiotics once improved 1.

Antibiotic Regimens

• Amoxicillin-clavulanate (40 mg/kg/day divided every 8 hours)
• Cephalexin (50-100 mg/kg/day divided every 6-8 hours)
• Trimethoprim-sulfamethoxazole (8 mg/kg/day of trimethoprim component divided every 12 hours) are commonly recommended for 7-10 days for uncomplicated UTIs 1.

Additional Considerations

• Adequate hydration is essential during treatment.
• Parents should ensure the child completes the full antibiotic course even if symptoms improve quickly.
• Follow-up urine cultures are recommended for infants and children with recurrent infections or anatomical abnormalities.
• Preventive measures include proper wiping techniques (front to back for girls), regular urination, adequate fluid intake, and avoiding bubble baths 1. These infections require prompt treatment as delayed therapy can lead to kidney scarring, especially in young children whose immune systems are still developing.

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 treatment for Urinary Tract Infection (UTI) in pediatrics 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
• 66-88 lb (30-40 kg): 1.5 to 2 tablets every 12 hours

• The treatment should not be used in pediatric patients less than 2 months of age.
• For patients with impaired renal function, a reduced dosage should be employed, with the following guidelines:

• Creatinine clearance above 30 mL/min: usual standard regimen
• Creatinine clearance 15-30 mL/min: half the usual regimen
• Creatinine clearance below 15 mL/min: use not recommended 3 3.

From the Research

Treatment Options for Urinary Tract Infections (UTIs) in Pediatrics

• The treatment of UTIs in children typically involves antibiotic therapy, with the choice of antibiotic depending on the severity of the infection and the presence of any underlying medical conditions 4, 5, 6.
• For febrile UTIs, initial treatment may involve amikacin, which remains active against the majority of E-ESBL strains 4.
• In some cases, parenteral antibiotic therapy may be recommended, particularly for infants under 2 months or children who are toxic-looking, hemodynamically unstable, immunocompromised, or unable to tolerate oral medication 5, 6.
• Oral antibiotics may be used to complete a course of treatment, typically lasting 7-14 days, depending on the severity of the infection and the child's response to treatment 5, 7, 6.

Specific Treatment Guidelines

• Neonates under 28 days with a febrile UTI should be hospitalized and treated with parenteral amoxicillin and cefotaxime 5.
• Infants between 28 days and 3 months with a febrile UTI should be hospitalized and treated with a third-generation cephalosporin or gentamicin 5.
• Children with complicated pyelonephritis should be hospitalized and treated with parenteral ceftriaxone or gentamicin, followed by oral antibiotics to complete a 10-14 day course of treatment 5.
• Children with uncomplicated pyelonephritis may be treated as outpatients with oral antibiotics, but should be rehydrated and monitored closely 5.

Antibiotic Resistance and Stewardship

• The increasing prevalence of antibiotic-resistant E-ESBL strains highlights the need for judicious use of antibiotics and antimicrobial stewardship in the treatment of UTIs in children 4, 7.
• Recent studies have identified targets for reducing unnecessary antibiotic exposure, including improving diagnostic accuracy and standardizing antimicrobial duration 7.