What medications are used to treat urinary tract infections (UTIs) in pediatric patients?

From the Guidelines

Medications used to treat urinary tract infections (UTIs) in pediatric patients include antibiotics such as trimethoprim-sulfamethoxazole, amoxicillin, and nitrofurantoin.

Key Points

• The choice of antibiotic depends on the severity of the infection, the age of the child, and the presence of any underlying medical conditions 1.
• For children with vesicoureteral reflux (VUR), continuous antibiotic prophylaxis (CAP) may be recommended to prevent recurrent febrile UTIs, especially in those with high-grade VUR or other risk factors 1.
• The American Academy of Pediatrics recommends that children with UTIs be treated with oral antibiotics for 7 to 14 days, with close clinical follow-up to monitor for recurrent infections 1.
• In some cases, surgical intervention may be necessary to correct underlying anatomical abnormalities, such as VUR 1.
• The use of prophylactic antibiotics to prevent UTIs in children with VUR is a topic of ongoing debate, with some studies suggesting that it may be beneficial in certain cases, while others have raised concerns about the risk of antibiotic resistance 1.

Medication Details

• Trimethoprim-sulfamethoxazole is commonly used for CAP in children with VUR, but should be avoided in infants under 6 weeks due to the risk of hepatic injury 1.
• Amoxicillin and nitrofurantoin are also commonly used antibiotics for treating UTIs in children, with nitrofurantoin generally avoided in children under 4 months due to the risk of hemolytic anemia 1.
• The dosage and duration of antibiotic treatment will depend on the specific circumstances of the child's infection and should be determined by a healthcare professional 1.

From the Research

Medications Used to Treat Urinary Tract Infections (UTIs) in Pediatric Patients

• The following medications are used to treat UTIs in pediatric patients:
  • Cephalexin, a narrow-spectrum (first-generation) cephalosporin antibiotic 2
  • Nitrofurantoin, which has low microbial resistance rates and can be used empirically for treating uncomplicated cystitis in children >1 month of age 3
  • Trimethoprim-sulfamethoxazole, although resistance has increased and should be avoided unless local susceptibility data are available 3
  • Cefdinir, which is often prescribed empirically, but may be an unnecessarily broad choice 4
  • Sulfamethoxazole-trimethoprim, which is commonly prescribed, but may not be the best choice due to increasing resistance rates 4
  • Amoxicillin-clavulanate, which is a drug of choice in the treatment of acute uncomplicated UTI 5
  • Parenteral antibiotic therapy, such as intravenous ampicillin and intravenous/intramuscular gentamycin, or a third-generation cephalosporin, which 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 5
  • Ceftriaxone or gentamicin, which can be administered parenterally and given each 24 h until the infant is afebrile for 24 hours 6

Treatment Guidelines

• The choice of antibiotics should take into consideration local data on antibiotic resistance patterns 3, 5
• Urinalysis and urine culture should be performed when UTI is suspected 4, 5
• Prompt antibiotic therapy is indicated for symptomatic UTI based on clinical findings and positive urinalysis to eradicate the infection and improve clinical outcome 5
• Routine antimicrobial prophylaxis is rarely justified, but continuous antimicrobial prophylaxis should be considered for children with frequent febrile UTI 5