From the Guidelines
The recommended duration of intramuscular (IM) antibiotic therapy for urinary tract infections (UTIs) in children is typically 2-3 days, followed by oral antibiotics to complete a total 7-10 day course. According to the most recent evidence from 1, the initial IM therapy is usually reserved for children who cannot tolerate oral medications, have pyelonephritis, appear toxic, or are at high risk for complications. Common IM antibiotics used include ceftriaxone (50 mg/kg per dose every 24 h) or gentamicin (4 mg/kg per dose every 24 h). After clinical improvement with IM therapy, most children can be switched to oral antibiotics such as cefixime, amoxicillin-clavulanate, or trimethoprim-sulfamethoxazole based on culture sensitivity results. Some key points to consider when treating UTIs in children include:
- The total course of therapy should be 7 to 14 days, as recommended by 1
- Parenteral administration of an antimicrobial agent should be considered when compliance with obtaining an antimicrobial agent and/or administering it orally is uncertain
- Local patterns of susceptibility of coliforms to antimicrobial agents should be taken into account during selection of an antimicrobial agent
- Agents that are excreted in the urine but do not achieve therapeutic concentrations in the bloodstream, such as nitrofurantoin, should not be used to treat febrile infants with UTIs. The rationale for this approach is that parenteral antibiotics rapidly achieve therapeutic blood levels to control the infection, while the transition to oral therapy allows for completion of treatment with less invasiveness and reduced healthcare costs.
From the Research
IM Reception for UTI in Children
- The optimal duration of antibiotic therapy for urinary tract infection (UTI) in pediatric patients is still unclear, but some studies suggest that a short course of antibiotic therapy may be feasible in children with afebrile UTI 2.
- A study found that five-day intramuscular antibiotic therapy could be effective in the treatment of lower UTI in children, with no correlation between recurrence and the therapy given 3.
- For febrile urinary tract infections, initial treatment with amikacin is recommended, which remains active against the majority of E-ESBL strains 4.
- The duration of IM reception for UTI in children is not explicitly stated in the provided studies, but one study mentions a five-day intramuscular antibiotic therapy 3.
- It is essential to note that the treatment options and durations may vary depending on the specific circumstances, such as the presence of urinary tract abnormalities or the type of pathogen isolated from urine cultures 2, 3, 4, 5, 6.