What is the recommended antibiotic for pediatric Urinary Tract Infection (UTI)?

From the Guidelines

For pediatric urinary tract infections (UTIs), the first-line antibiotic treatment is typically amoxicillin-clavulanate at a dose of 20-40 mg/kg per day in 3 doses, as recommended by the most recent and highest quality study 1.

Key Considerations

• The choice of antibiotic should be guided by local resistance patterns and adjusted based on urine culture results when available 1.
• Children should complete the full course of antibiotics even if symptoms improve quickly.
• Adequate hydration is essential during treatment to help flush bacteria from the urinary tract.
• For more severe infections or pyelonephritis, ceftriaxone at 50-75 mg/kg/day may be initiated, often followed by oral antibiotics once the child improves 1.
• The use of prophylactic antibiotics at lower doses may be considered for recurrent UTIs, and underlying anatomical abnormalities should be evaluated 1.

Antibiotic Options

• Amoxicillin-clavulanate: 20-40 mg/kg per day in 3 doses 1
• Cefixime: 8 mg/kg per day in 1 dose 1
• Cefpodoxime: 10 mg/kg per day in 2 doses 1
• Cefprozil: 30 mg/kg per day in 2 doses 1
• Cefuroxime axetil: 20-30 mg/kg per day in 2 doses 1
• Cephalexin: 50-100 mg/kg per day in 4 doses 1

Important Notes

• The most recent study 1 recommends amoxicillin-clavulanate, nitrofurantoin, and sulfamethoxazole-trimethoprim as first-choice options for the treatment of lower urinary tract infections.
• Fluoroquinolones are not recommended due to the emergence of resistance and the availability of alternative treatments 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 recommended antibiotic for pediatric UTI is sulfamethoxazole and trimethoprim, with a dose of 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 the following guidelines:

• 22-44 lb (10-20 kg): 1 tablet every 12 hours
• 66 lb (30 kg): 1½ tablets every 12 hours
• 88 lb (40 kg): 2 tablets or 1 DS tablet every 12 hours

From the Research

Antibiotic Treatment for Pediatric UTI

• The treatment options for urinary tract infections (UTIs) in children are based on recommendations published by the Groupe de Pathologie Infectieuse de Pédiatrique (GPIP-SFP) 3.
• A positive urine dipstick for leukocytes and/or nitrites should precede a urine culture examination and any antibiotic therapy, except in rare situations such as newborns, neutropenia, or sepsis 3.
• The proportion of Escherichia coli strains resistant to extended-spectrum ß-lactamases (E-ESBL) has remained stable over the last ten years, between 7% and 10% in pediatrics 3.

Antibiotic Resistance and Treatment

• Multidrug resistance in pediatric UTIs is a concern, with E. coli resistance to ampicillin peaking in toddlers (52.8%) and being high in preteens (52.1%), infants (50.4%), and teens (40.6%) 4.
• The most common co-resistance in all age groups is ampicillin/TMP-SMZ 4.
• Amikacin remains active against the majority of E-ESBL strains and could be prescribed as monotherapy for patients in pediatric emergency departments or otherwise hospitalized patients 3.

Epidemiology and Treatment Trends

• Cystitis and pyelonephritis remain common ED presentations, representing nearly 2% of all pediatric ED visits, with notable shifts in antibiotic selection over time 5.
• Third-generation cephalosporins, first-generation cephalosporins, and ampicillin are commonly used antibiotics for cystitis and pyelonephritis in pediatric patients 5.
• First-generation cephalosporin use has risen over time, while ampicillin and ciprofloxacin use have declined 5.

Diagnosis and Management

• The diagnosis and management of UTIs in children are still controversial, with long-term complications such as renal scarring, hypertension, and renal failure being a concern 6.
• The risk of developing long-term complications after a UTI is extremely low, and evidence suggests selective imaging to a select group of children at risk 6.
• Immediate antimicrobial therapy is recommended rather than delayed treatment or symptom management with ibuprofen alone 7.