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

From the Guidelines

To treat a pediatric urinary tract infection (UTI), start with a medical evaluation to confirm the diagnosis through urinalysis and possibly urine culture, and prescribe oral antibiotics for 7-14 days, with common first-line medications including amoxicillin-clavulanate, cephalexin, or trimethoprim-sulfamethoxazole, as recommended by the American Academy of Pediatrics 1.

Key Considerations

• For mild to moderate infections in children over 2 months, oral antibiotics are typically prescribed for 7-14 days.
• Common first-line medications include:
  • Amoxicillin-clavulanate (20-40 mg/kg/day divided into three doses) 1
  • Cephalexin (50-100 mg/kg/day divided into four doses) 1
  • Trimethoprim-sulfamethoxazole (6-12 mg/kg/day of trimethoprim component divided into two doses) 1
• For infants under 2 months or children with severe infections, hospitalization with intravenous antibiotics may be necessary.
• Ensure your child drinks plenty of fluids to help flush bacteria from the urinary tract.
• Acetaminophen or ibuprofen can be given for fever or discomfort at age-appropriate doses.
• Complete the full course of antibiotics even if symptoms improve quickly to prevent recurrence or antibiotic resistance.
• Contact a doctor immediately if your child develops high fever, persistent vomiting, worsening pain, or appears very ill.

Recent Guidelines

The European Association of Urology/European Society of Paediatric Urology guidelines suggest that continuous antibiotic prophylaxis (CAP) may be beneficial in preventing recurrent febrile UTIs in children with vesicoureteral reflux (VUR), but the decision to use CAP should be individualized and based on the child's risk factors and medical history 1.

Important Notes

• UTIs in children require prompt treatment to prevent kidney damage, especially in younger children whose urinary systems are still developing.
• The choice of antibiotic and duration of treatment should be guided by the severity of the infection, the child's age and medical history, and local patterns of antimicrobial resistance.

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 and older: WeightDose – every 12 hours lbkgTablets 2210- 44201 66301 ½ 88402 or 1 DS tablet

The treatment for a pediatric 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 kg: 1 tablet
  • 66-88 kg: 1 ½ or 2 tablets
• Note that this medication is not recommended for use in pediatric patients less than 2 months of age.

From the Research

Treatment Options for Pediatric UTI

• The treatment of urinary tract infections (UTIs) in children typically involves the use of oral antibiotics 3.
• The choice of antibiotic is guided by the clinical presentation, the patient's ability to take oral agents, and the local resistance pattern of Escherichia coli (E. coli), the most common pathogen 3.
• Recommended first-line empiric therapy for upper UTI in children includes pivmecillinam or amoxicillin-clavulanic acid 3.
• For lower UTI, nitrofurantoin is an excellent first choice 3.

Antibiotic Resistance and Treatment

• The increasing resistance of E. coli to certain antibiotics, such as amoxicillin and trimethoprim-sulfamethoxazole, has led to a shift in treatment recommendations 3, 4.
• New antimicrobial agents, such as fosfomycin and pivmecillinam, have been recommended for the treatment of UTIs caused by antibiotic-resistant bacteria 4.
• The use of fluoroquinolones, which have been associated with adverse events and antibiotic resistance, is discouraged for the treatment of uncomplicated UTIs 4, 5.

Considerations for Pediatric Patients

• Pediatric patients with UTIs require careful consideration of antibiotic treatment options, taking into account the patient's age, weight, and renal function 6, 7.
• The use of sulfonamides, trimethoprim-sulfamethoxazole, and nitrofurantoin has been recommended for the treatment of UTIs in pediatric patients, although resistance patterns and local guidelines should be considered 3, 7.