What is the appropriate antibiotic coverage for Urinary Tract Infections (UTI) in pediatric (peds) patients?

From the Guidelines

Pediatric UTI Antibiotic Coverage: For pediatric patients with uncomplicated urinary tract infections (UTIs), amoxicillin/clavulanate (20-40 mg/kg/day divided every 8-12 hours) or trimethoprim/sulfamethoxazole (6-12 mg/kg/day divided every 12 hours) are recommended empiric antibiotic therapies for 7-10 days 1. Alternatively, cefixime (8 mg/kg/day once daily) or cefpodoxime (10 mg/kg/day divided every 12 hours) may be used for 7-10 days 1.

Key Considerations

• The choice of antibiotic should be based on local patterns of susceptibility of coliforms to antimicrobial agents, particularly trimethoprim-sulfamethoxazole and cephalexin 1.
• For complicated UTIs or pyelonephritis, intravenous ceftriaxone (50-75 mg/kg/day once daily) may be initiated, with oral step-down therapy considered after 24-48 hours of clinical improvement 1.
• Nitrofurantoin should not be used to treat febrile infants with UTIs, as it may not achieve therapeutic concentrations in the bloodstream 1.

Treatment Duration

• The total course of therapy should be 7 to 14 days, with a minimum duration of 7 days 1.
• There is evidence that 1- to 3-day courses for febrile UTIs are inferior to courses in the recommended range 1.

Additional Options

• Other cephalosporins, such as cefprozil (30 mg/kg/day divided every 12 hours) or cefuroxime axetil (20-30 mg/kg/day divided every 12 hours), may also be used for 7-10 days 1.
• Sulfonamide (6-12 mg/kg trimethoprim and 30-60 mg/kg sulfamethoxazole per day divided every 12 hours) or sulfisoxazole (120-150 mg/kg per day divided every 8 hours) may be alternative options 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 10 - 44 20 1 66 30 1½ 88 40 2 or 1 DS tablet

The appropriate antibiotic coverage for Urinary Tract Infections (UTI) in pediatric patients 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 3.

• The dosage is based on the child's weight, with the following guidelines:

• 22-44 lb (10-20 kg): 1 tablet every 12 hours
• 66-88 lb (30-40 kg): 1.5-2 tablets every 12 hours

• Pediatric patients less than 2 months of age should not be given this medication.

From the Research

Antibiotic Coverage for Urinary Tract Infections (UTI) in Pediatric Patients

• The choice of empiric antibiotic treatment for UTI in pediatric patients is based on knowledge of the local susceptibility of urinary bacteria to antibiotics 4.
• For neonates younger than 28 days with a febrile UTI, parenteral amoxicillin and cefotaxime are recommended, followed by oral antibiotic treatment to complete 14 days of therapy 5.
• Infants from 28 days to 3 months who appear clinically ill with a febrile UTI should be hospitalized and treated with parenteral administration of a 3rd generation cephalosporin or gentamicin, followed by oral antibiotic treatment to complete 14 days of therapy 5.
• Children with complicated pyelonephritis should be hospitalized and treated with parenteral ceftriaxone or gentamicin, followed by oral antibiotic treatment to complete 10 to 14 days of therapy 5.
• First generation cephalosporins are the preferred empiric antibiotics for febrile UTI in outpatient children, while amoxicillin/clavulanate is not favorable due to resistance rates over 20% 4.
• Short courses of twice-daily cephalexin appear to be a safe and effective option for the empiric treatment of uncomplicated UTIs 6.
• A short course of antibiotic therapy is feasible in children with afebrile UTI, but more studies are warranted to safely establish an optimal treatment duration for children with febrile UTI 7.
• Short-duration (3-5 days) antibiotic treatment of uncomplicated UTI in children >24 months of age is equivalent to longer-duration antibiotic treatment, with added benefits of antibiotic stewardship 8.

Specific Antibiotic Recommendations

• Ceftriaxone or gentamicin should be administered parenterally for children with complicated pyelonephritis or uncomplicated pyelonephritis 5.
• First or second generation cephalosporin, trimethoprim-sulfamethoxazole, or amoxicillin-clavulanic acid are recommended empiric oral antibiotic treatments for UTI in children 4.
• Cephalexin is a preferred oral antibiotic for empiric treatment of UTIs, with a twice-daily dosing regimen 6.

Treatment Duration

• The optimal treatment duration for UTI in pediatric patients remains elusive, but short courses of antibiotic therapy may be feasible in children with afebrile UTI 7.
• Short-duration (3-5 days) antibiotic treatment of uncomplicated UTI in children >24 months of age is equivalent to longer-duration antibiotic treatment 8.
• Treatment duration for complicated UTI or febrile UTI may need to be longer, typically 10 to 14 days 5, 7.