Oral treatment of febrile urinary tract infection in children: Feasibility and follow-up

Abstract

Objective To assess the feasibility of oral treatment protocol with available oral antibiotics in Belgium in children admitted in a emergency unit in a single center for a febrile urinary tract infection. Methods Participants/design – retrospective analysis of the outcomes of 316 children, aged 15 days to 15 years old presenting for a febrile UTI (positive dipstick for leucocyte esterase and/or nitrite + positive culture (> 1 bacteria/μL, > 50 × 10 3 and > 100 × 10 3 for suprapubic aspiration, bladder catheterization and mi-stream samples, respectively) from 1/01/2012 to 04/05/2015 in the pediatric emergency department of La clinique de l’Esperance. Methods – Children ≥ 3 months with a first episode of febrile UTI were eligible for the oral treatment if there was no vomiting for 24 h. Exclusion criteria were antibiotic therapy within the last 2 weeks, urinary tract surgery within the last month, history of dilated uropathy, abnormal antenatal ultrasound, renal transplantation, intermittent catheterization and parental inability to understand the treatment and the follow-up. The first dose was administered in the department. Children not fulfilling these criteria were hospitalized to receive IV antibiotic therapy and data were collected in order to compare epidemiology. The parents were called within the 72 h after admission to control time to apyrexia, vomiting, compliance and bacterial sensitivity to the given antibiotic. Primary outcome was to confirm the feasibility of oral treatment with the available antibiotics in Belgium where oral third generation cephalosporins are not available. Secondary outcome was the comparison of the sensitivity of bacteria identified in first episodes of UTI and in children with recurrent episode of UTI. Results One hundred and fifty five (52%) could be treated orally, 91 with amoxycillin–clavulanate, 71 with cefuroxime–axetil, 3 with TMP–SMX. The main reasons of ineligibility to the oral treatment were age Discussion–conclusion Treatment with oral antibiotic can be implemented in the emergency department in a selected population providing a strict follow-up to assess parent's ability to administer effectively the treatment and their possibilities of representing the child in case of failure. Oral treatment with amoxycilline–clavulanate or cefuroxime–axetil is a safe option for a first episode of UTI in children ≥ 3 months in our region. Thirteen percent of these children will experience vomiting which will hinder appropriate administration of the treatment. Oral cefuroxime–axetil is an option for children with recurrent episode of UTI as the causative bacteria was sensitive to this antibiotic in 98%.