From the Guidelines
The best antibiotic for a seven-year-old female with a simple Urinary Tract Infection (UTI) and no significant medical history is amoxicillin-clavulanate or a cephalosporin, such as cefixime or cefpodoxime, based on local resistance patterns.
Treatment Options
- Amoxicillin-clavulanate: 20–40 mg/kg per day in 3 doses 1
- Cephalosporin:
Considerations
- Local patterns of susceptibility of coliforms to antimicrobial agents should be considered when selecting an antibiotic 1
- The total course of therapy should be 7 to 14 days 1
- Nitrofurantoin is not recommended for febrile infants with UTIs, as it may not achieve therapeutic concentrations in the bloodstream 1
- The American Academy of Pediatrics recommends amoxicillin-clavulanic acid and sulfamethoxazole-trimethoprim for empiric treatment of UTIs in children aged 2-24 months 1
- The European Association of Urology & European Society for Paediatric Urology recommends antimicrobial choice based on local resistance patterns for urinary tract infections in children 1
From the Research
Treatment Options for Urinary Tract Infections (UTIs) in Children
The choice of antibiotic for a seven-year-old female with a simple UTI and no significant medical history should be based on local data on antibiotic resistance patterns 2.
- A second or third generation cephalosporin and amoxicillin-clavulanate are considered drugs of choice in the treatment of acute uncomplicated UTI 2.
- Nitrofurans and fosfomycin trometamol are also considered optimal drugs in terms of efficiency and environmental safety in UTI 3.
- For lower UTI, nitrofurantoin is an excellent first choice 4.
Considerations for Antibiotic Selection
When selecting an antibiotic, it is essential to consider the following factors:
- Pharmacokinetics, with preference given to drugs with renal excretion 3
- Natural activity of the antibiotic against the pathogens that cause UTI 3
- Local resistance pattern 2, 3
- Environmental safety of therapy, with consideration of the potential impact on the gastrointestinal and urinary tract microbiota 3
Specific Antibiotic Recommendations
- Pivmecillinam or amoxicillin-clavulanic acid are recommended as first-line empiric therapy for upper UTI 4
- Nitrofurantoin is recommended as a first choice for lower UTI 4
- Ampicillin and gentamicin are traditionally the empiric treatment of choice for UTI in infants, but local antibiotic resistance patterns should be considered 5