Pediatric UTI Treatment
For pediatric urinary tract infections (UTIs), the recommended treatment is oral antibiotics for 7-14 days, with specific antibiotic choice guided by local resistance patterns. 1
First-Line Treatment Options
- Most children with UTI can be treated with oral antibiotics unless they appear toxic or cannot retain oral intake 1, 2
- Recommended first-line oral antibiotics include:
- Amoxicillin-clavulanate: 20-40 mg/kg per day in 3 divided doses 1
- Cephalosporins: cefixime, cefpodoxime, cefprozil, cefuroxime axetil, or cephalexin 1, 3
- Trimethoprim-sulfamethoxazole (for children ≥2 months): 8 mg/kg trimethoprim and 40 mg/kg sulfamethoxazole per 24 hours, divided in two doses every 12 hours 4
Treatment Duration
- For uncomplicated cystitis: 5-7 days of oral antibiotics 5, 6
- For febrile UTIs/pyelonephritis: 7-14 days total treatment duration 7, 1
- Short-course therapy (2-4 days) has been shown to be as effective as standard duration (7-14 days) for lower tract UTI in children 6
Special Considerations by Age
Neonates (<28 days)
- Hospitalization with parenteral antibiotics (amoxicillin and cefotaxime)
- After 3-4 days of clinical improvement, complete 14 days with oral antibiotics 5, 8
Infants (28 days - 3 months)
- If clinically ill: hospitalization with parenteral 3rd generation cephalosporin or gentamicin
- If not acutely ill: outpatient management with daily parenteral antibiotics until afebrile for 24 hours
- Complete 14 days total therapy with oral antibiotics 5
Older Children
- Uncomplicated pyelonephritis: parenteral antibiotics until afebrile for 24 hours, then oral antibiotics to complete 10-14 days 5, 9
- Cystitis: oral antibiotics for 5-7 days 5, 6
Important Considerations
- Avoid nitrofurantoin for febrile UTIs as it doesn't achieve adequate serum concentrations to treat pyelonephritis 1, 2
- Base antibiotic choice on local resistance patterns of common uropathogens 1, 2
- Consider renal and bladder ultrasonography for first febrile UTI to detect anatomical abnormalities 2
- Avoid treating asymptomatic bacteriuria 2
Antibiotic Prophylaxis
- Continuous antibiotic prophylaxis (CAP) may benefit select high-risk children with vesicoureteral reflux (VUR) 7
- High-risk groups include: uncircumcised males, presence of bladder and bowel dysfunction, and high-grade reflux 7
- Common prophylactic antibiotics: trimethoprim-sulfamethoxazole, amoxicillin, and nitrofurantoin at quarter to half of therapeutic dose 7
- TMP-SMX should be avoided in infants <6 weeks due to risk of hepatic injury 7
- Nitrofurantoin should be avoided before age 4 months due to risk of hemolytic anemia 7