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

From the Guidelines

Pediatric UTI treatment should prioritize oral antibiotics, such as nitrofurantoin, for uncomplicated cystitis, and parenteral antibiotics, such as ceftriaxone, for pyelonephritis or complicated cases, as recommended by the most recent guidelines 1. The choice of antibiotic regimen depends on the child's age, severity of infection, and local resistance patterns.

• For uncomplicated UTIs in children, oral antibiotics such as amoxicillin-clavulanate (20-40 mg/kg/day divided every 8 hours), cephalexin (25-50 mg/kg/day divided every 6-8 hours), or trimethoprim-sulfamethoxazole (6-12 mg/kg/day of trimethoprim component divided every 12 hours) are commonly prescribed for 7-10 days.
• For infants under 3 months or children with pyelonephritis, parenteral antibiotics may be necessary, such as ceftriaxone (50-75 mg/kg/day) or gentamicin (5-7.5 mg/kg/day). Adequate hydration is essential during treatment to help flush bacteria from the urinary tract.
• Parents should ensure the child completes the full course of antibiotics even if symptoms improve quickly. Follow-up urine cultures may be needed to confirm resolution, especially in younger children or those with recurrent infections. Preventive measures include proper wiping techniques (front to back for girls), regular urination, avoiding bubble baths, and treating constipation if present. These infections require prompt treatment because untreated UTIs can lead to kidney damage, especially in young children whose immune systems are still developing, as highlighted in previous studies 1.

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 or older: Weight Dose-every 12 hours lb kg Tablets 22-44 10-20 1 66-88 30-40 2 (400 mg/80 mg) or 1 (DS) tablet

The recommended pediatric dosage for urinary tract infections 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 a minimum age of 2 months.
• The dosage should not be used in pediatric patients less than 2 months of age.

From the Research

Pediatric UTI Treatment

• The treatment of urinary tract infections (UTIs) in children 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.
• Most children with both upper and lower UTI can safely be treated with oral antibiotics, with pivmecillinam or amoxicillin-clavulanic acid recommended as first-line empiric therapy for upper UTI 3.
• For lower UTI, nitrofurantoin is an excellent first choice 3.
• The increasing prevalence of resistance to commonly used antibiotics, such as trimethoprim-sulfamethoxazole, has led to a gradual evolution in the antibiotics used to treat UTIs 4.
• In the treatment of UTIs in children, antibiotic prophylaxis and evaluation should be based on an evidence-based approach, with a selective approach recommended based on evidence 5.

Antibiotic Resistance

• The resistance rate for trimethoprim-sulfamethoxazole was found to be 34% in one study, with all resistant microorganisms being E. coli 4.
• The resistance rate for fluoroquinolones was found to be 16.4% in the same study, with resistant microorganisms being E. coli 4.
• Fosfomycin was found to be a viable option for the treatment of uncomplicated UTIs, with a low resistance rate of 2.4% 6.
• The use of new antimicrobials, such as ceftazidime-avibactam and meropenem/vaborbactam, may be necessary for the treatment of UTIs caused by multidrug-resistant organisms 7.

Treatment Options

• The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam 7.
• Second-line options include oral cephalosporins, such as cephalexin or cefixime, fluoroquinolones, and β-lactams, such as amoxicillin-clavulanate 7.
• Parenteral treatment options for UTIs due to ESBLs-producing Enterobacteriales include piperacillin-tazobactam, carbapenems, and ceftazidime-avibactam 7.