Treatment Of Urinary Tract Infection In Children Research Articles

A Review of Urinary Tract Infections in Pediatric Patients

Urinary tract infections (UTIs) are a common and significant health concern in children. The etiology of UTIs in children can vary depending on various factors, including age, gender, and underlying conditions. This comprehensive review aims to explore the etiology, pathogens involved, etiological evaluation by age group, diagnosis, differential diagnosis, follow-up, treatment, and prognosis of UTIs in children. Introduction: Urinary tract infections (UTIs) are bacterial infections that affect the urinary system, comprising the kidneys, ureters, bladder, and urethra. In children, UTIs can cause substantial morbidity if not promptly diagnosed and treated. Understanding the etiology and appropriate management strategies is crucial for healthcare providers involved in the care of pediatric patients. Etiology of UTIs in Children: UTIs in children can have various etiological factors, with the most common cause being bacterial invasion of the urinary tract. The majority of UTIs are caused by Gram-negative bacteria, with Escherichia coli being the predominant pathogen. Other potential pathogens include Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus saprophyticus. Viral and fungal infections can also contribute to UTIs in certain cases. Pathogens Involved in the Etiology of UTIs: A detailed examination of the pathogens involved in UTIs is essential for appropriate diagnosis and treatment. E. coli, which colonizes the gastrointestinal tract, is responsible for the majority of UTIs in children. Understanding the antibiotic resistance patterns of these pathogens is crucial in selecting appropriate antimicrobial therapy. Etiological Evaluation by Age Group: The etiological evaluation of UTIs in children varies according to age group. Infants, young children, and older children may exhibit different risk factors and underlying conditions that contribute to UTIs. An age-specific approach is necessary to identify the potential causes, such as urinary tract abnormalities, voiding dysfunction, or anatomical abnormalities. Diagnosis of UTIs in Children: Accurate and timely diagnosis of UTIs is crucial to prevent complications and recurrent infections. Various diagnostic tools, including urinalysis, urine culture, and imaging studies, aid in identifying UTIs and determining the severity of infection. Clinical symptoms, such as fever, dysuria, and urinary frequency, must also be considered in the diagnostic process. Differential Diagnosis: UTIs can present with symptoms similar to other conditions, leading to diagnostic challenges. Differential diagnoses may include conditions such as pyelonephritis, urinary tract stones, urethritis, and sexually transmitted Open Access Journal of Urology & Nephrology 2 Parlak ME and Kucukkelepce O. A Review of Urinary Tract Infections in Pediatric Patients. J Urol Nephrol 2023, 8(3): 000238. Copyright© Parlak ME and Kucukkelepce O. infections. An understanding of these potential differentials is essential to avoid misdiagnosis and provide appropriate treatment. Follow-up and Monitoring: After initiating treatment for UTIs, regular follow-up and monitoring are necessary to ensure the resolution of infection, assess treatment response, and prevent complications. Monitoring urine culture results, renal function, and imaging studies play a vital role in evaluating the effectiveness of treatment and detecting any underlying conditions that require further management. Treatment of UTIs in Children: Treatment of UTIs in children involves antimicrobial therapy targeted at the identified pathogen. The choice of antibiotics should consider local resistance patterns, age of the child, and severity of infection. Adequate hydration, symptomatic relief, and addressing predisposing factors are also important in the overall management of UTIs. Prognosis: With timely diagnosis and appropriate treatment, the prognosis for UTIs in children is generally favorable. However, the presence of underlying conditions, delayed diagnosis, or recurrent infections can influence the long-term outcome. Identifying and managing risk factors and promoting good urinary hygiene can help prevent future UTIs and potential complications. Conclusion: Urinary tract infections in children present unique challenges in terms of etiology, diagnosis, and management. Understanding the etiological factors, pathogens involved, appropriate diagnostic approaches, and treatment strategies is crucial for healthcare providers. By implementing a comprehensive approach that considers age-specific evaluations, accurate diagnosis, and effective treatment, healthcare professionals can ensure optimal outcomes and reduce the burden of UTIs in children.

Bacterial Profile and Antibiotic Resistance Pattern among Children with Urinary Tract Infections in Dr. Soetomo Hospital, Surabaya, Indonesia

Urinary tract infections (UTIs) are the most common infections in pediatric patients characterized by the growth of bacteria in the urine in significant numbers. Antibiotics remain the primary treatment of UTI in children. However, there has been an increase in antibiotic resistance to uropathogens worldwide due to their inappropriate and extensive uses. There is considerable geographical variation in the distribution of bacteria and antibiotic resistance pattern. Thus, to prevent further resistance and provide empirical antibiotic options, this study aims to determine the profile of bacteria and antibiotics resistance pattern among UTI pediatric patients in Dr. Soetomo Hospital. This study was performed by collecting data from the urine culture logbook at the Clinical Microbiology Laboratory of Dr. Soetomo Hospital in July-October 2019. The sample was UTI patients aged one day – 18 years due to bacterial infection with a colony count of ≥100,000 CFU/ml. In this study, 131 patients showed significant bacterial growth dominated by males and ages one month – 2 years. UTI were caused by gram-negative bacteria (74%) and gram-positive bacteria (26%), with the most bacteria found in each group were Escherichia coli and Enterococcus faecalis. E. coli showed ≥70% resistance to ampicillin, cefazoline, piperacillin, tetracycline, and trimethoprim-sulfamethoxazole. Comorbidities were dominated by hydronephrosis (10.98%), chronic kidney disease (9.79%) and hydrocephalus (8.09%). In conclusion, gram-negative bacteria were the leading cause of UTI in children with E. coli as the most common uropathogen, highly resistant to ampicillin and cefazolin. Gram-positive bacteria were less frequent with varied resistance patterns. Most common comorbidity was hydronephrosis.

Резистентність до протимікробних препаратів серед клінічних ізолятів, виділених при інфекції сечових шляхів у дітей

Актуальність. Інфекція сечових шляхів (ІСШ) — одна з основних причин госпіталізації дітей до стаціонару. Однією з основних причин неефективного лікування ІСШ у дітей є антибіотикорезистентність збудників ІСШ. Метою дослідження було визначення стану поширеності антибіотикорезистентності серед збудників інфекції сечових шляхів. Матеріали та методи. Дослідження антибіотикорезистентності проводилося на 61 клінічному ізоляті, що були виділені зі зразків сечі дітей, які були госпіталізовані з приводу захворювання на різні форми ІСШ. Визначення чутливості до 23 антимікробних препаратів здійснювалося за допомогою методу антимікробних дисків з подальшим визначенням зон затримок росту. Результати. Найбільшу ефективність щодо збудників інфекцій сечових шляхів мали представники групи аміноглікозидів (амікацин — до 91,9 % клінічних ізолятів, гентаміцин — до 82 %). Цефалоспорини ІІІ покоління мали різний рівень антибіотикорезистентності, що коливалася у межах від 11,8 % (цефтизоксим) до 42,5 % (цефподоксим). Зберігається високий рівень чутливості до синтетичних протимікробних препаратів: чутливість до фурагіну становила 89,8 %, до фосфоміцину — 86,5 %. Висновки. Рівень антибіотикорезистентності щодо збудників ІСШ значно варіює у різних антибактеріальних препаратів, а також залежно від форми ІСШ, тому проведення дослідження антибіотикорезистентності є важливим етапом в лікуванні хворих на ІСШ.

Multidrug-resistant and extended-spectrum beta-lactamase-producing uropathogens in children in Bhaktapur, Nepal

BackgroundThe emergence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing uropathogens has complicated the treatment of urinary tract infections (UTI). Paediatric UTI is a common illness, which if not treated properly, may lead to acute and long-term complications, such as renal abscess, septicaemia, and renal scarring. This study aimed to determine the prevalence of MDR and ESBL-producing uropathogens among children.MethodsDuring the study period (April 2017–April 2018), midstream urine samples were collected following aseptic procedures from children < 16 years in Siddhi Memorial Hospital. Standard culture and biochemical tests were performed to identify uropathogens and antimicrobial susceptibility test was done by modified Kirby-Bauer disc diffusion method following Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL-producing uropathogens were screened by ceftazidime (30 μg) and cefotaxime (30 μg) discs, and confirmed by the combination disc tests: ceftazidime + clavulanic acid (30/10 μg) or cefotaxime + clavulanic acid (30/10 μg) as recommended by CLSI.ResultsWe processed 5545 non-repeated urine samples from the children with symptoms of UTI. A significant growth of uropathogens was observed in 203 samples (3.7%). The median age of the children was 24 months (interquartile range (IQR), 12–53 months). Escherichia coli (n = 158, 77.8%) and Klebsiella pneumoniae (n = 30, 14.8%) were common among the uropathogens. Among them, 80.3% were resistant to amoxycillin and 51.2% were resistant to cotrimoxazole. Most of them were susceptible to amikacin, nitrofurantoin, and ofloxacin. MDR was detected in 34.5% (n = 70/203) and ESBL producers in 24.6% (n = 50/203) of them. The proportion of MDR isolates was higher in children < 5 years (n = 59/153, 38.6%) than children ≥ 5 years (n = 11/50, 22%) (P = 0.03).ConclusionsNitrofurantoin, ofloxacin, and amikacin can be used for the empirical treatment for UTI in children in Bhaktapur, Nepal. MDR and ESBL-producing uropathogens are prevalent; this warrants a continuous surveillance of antimicrobial resistance.

URINARY TRACT INFECTIONS IN CHILDREN

The review addresses the main issues related to the rational pharmacotherapy of urinary tract infection (UTI). UTIs are a common and important clinical problem in children. Among UTI causative agents in children are dominated by gram-negative bacteria, E. coli. According to modern clinical guidelines, the leading direction in the treatment of UTI in children is antibiotic therapy, which should be prescribed taking into account the sensitivity of microorganisms. Drugs of choice for UTI in children: cephalosporins or protected aminopenicillins

Prevalence and Antibiotic Resistance Patterns of Gram-Negative Uropathogens among Paediatric Patients in Nigeria

Objective: This study aimed to detect and compare the frequency and antibiotics resistant pattern of Gram-negative uropathogens implicated in urinary tract infections (UTIs) in paediatric patients attending some hospitals in Nigeria and to proffer recommendations for its management. Methods: Based on standard procedures, midstream urine samples were collected. Urinalysis was done as a preliminary diagnosis of UTI using Combi-9 test strip. Isolation of uropathogen was done and antibiotic sensitivity test was carried out using Kirby-Bauer technique. Results: Out of 489 samples collected, 130 (26.4%) was positive for UTI. The prevalence rate of UTI in the investigated areas such as Nsukka, Otukpo, Gboko and Kastina Ala was 31.8%, 17.5%, 34.3% and 17.1%, respectively. The prevalence of UTI was higher in males 81 (30.9%) than in females 49 (21.6%), but there was no statistically significant association between gender and UTI (p = 0.636). The prevalence of UTI was greater among the age of 2 - 5 years (28.2%) and decreased with the increase in age, although there was no significant association between UTI and the age groups (p = 0.870). Generally, Klebsiella pneumonae (88.8%) was the most dominant bacterium (it was even more in males), followed by E. coli (40.6%), which was more in females, then Pseudomonas spp. (45.0%) and Proteus mirabilis (13.8%). The in-vitro antibiotic susceptibility testing shows that the isolate was highly resistant to Augmentin, Cotrimoxazoel, Amoxicilin and Tetracycline, while some of the isolate shows intermediate resistant to Nitrofurantoin and Nalixidic acid. Ofloxacine and Gentamicin were the most effective antibiotics against the isolates from all the study areas. The isolates had a varied range of MICs and MBCs. Conclusion: K. pneumonia predominated all isolates. The resistant patterns of the isolates to some of the antibiotics show that the first line of antibiotics for treatment of UTI in children in these areas is Ofloxacine and Gentamicin.

Urinary Tract Infection in Children

Urinary tract infections (UTI) are common among children. In the past 20 years, a number of key trials have substantially changed practice, in addition to clarifying the natural history of children managed expectantly. It is now clear that among children with normal kidneys at presentation, chronic kidney disease and hypertension are rare. Improved antenatal ultrasound now detects most significant abnormalities of the kidney and urinary tract, particularly severe hypodysplasia, which is often associated with high-grade vesico-ureteric reflux (VUR). This review aims to summarize the evidence-based treatment of UTI in children. There is no difference in symptomatic, microbiologic, or renal outcomes between intravenous and oral antibiotics in treating acute, febrile infection. Long-term antibiotic prophylaxis results in a statistically but not clinically significant reduction in recurrence among young children, with or without VUR. Trials to-date have failed to demonstrate that the surgical correction of VUR confers any additional benefit, which may be because the natural history of VUR is to resolution with time and/or that other factors are more important determinants of outcome. A more conservative approach to the management of UTI is warranted for most children. Antibiotic prophylaxis, voiding cystourethrography, and surgery for VUR are not indicated following an initial or infrequent UTI. These measures may have a role in selected subgroups of children at high risk of kidney disease, but this remains a hypothesis pending the results of ongoing trials.

Diagnosis and treatment of urinary tract infections in children: what’s new?

Urinary tract infection (UTI) is one of the most frequent problems in children, especially early age. A practicing pediatrician, pediatric urologist, nephrologist is frequently faced with the problem of diagnosis and treatment of UTI. Clinical manifestations of UTI in children are diverse and depend on the age and sex of child, severity of the inflammatory process, presence and nature of comorbidity. The experts dealing with the problem of UTI in children in different countries initiated the establishment of clinical guidelines that can assist clinicians in the diagnosis and treatment of UTI in children. The paper presents national European recommendations for the treatment and diagnosis of UTI in pediatrics.

Probiotics for Prophylaxis and Treatment of Urinary Tract Infections in Children

Context: Urinary tract infection (UTI) is a common and important problem during childhood that may cause chronic morbidities. Live beneficial microorganisms called probiotics have been investigated for their use in the prophylaxis and treatment of UTIs in children. Evidence Acquisition: We aimed to discuss data about use, mechanisms and effects of probiotics on pediatric UTIs. We searched the literature, including PubMed, Medline and Cochrane databases from January 2001 to May 2016, and limited the search to English language. We used the key words probiotics, urinary tract infection, treatment, prophylaxis and children. Results: Probiotics inhibit uropathogens by competition for receptors and nutrients, direct killing, immune modulation and production of inhibitory metabolites. There are many organisms that have been used as probiotics. Lactobacillus sp., Bifidobacterium sp. and Saccharomyces boulardii are the most commonly used and investigated probiotics. Although there are various benefits of probiotics for the pediatric population, some reports indicate rare complications such as bacteremia, sepsis, endocarditis, meningitis, UTI, abscesses, fungemia, pneumonia and chorioamnionitis. However, these are much less than the benefits of probiotics yet should be kept in mind. Continuing laboratory and clinical studies are encouraging the use of this strategy for the prevention and treatment of UTI in children. Conclusions: Probiotics can be used as a natural and efficient alternative to antibiotics in UTI prophylaxis and treatment in children.

Determinants of practice patterns in pediatric UTI management

Urinary tract infection (UTI) affects 10% of girls and 3% of boys by age 16. Both the American Academy of Pediatrics and National Institute for Health and Clinical Excellence Guidelines recommend urine testing prior to initiation of antibiotic treatment and the use of local antibiograms to guide empiric antibiotic therapy. Urine culture results not only provide the opportunity to halt empiric therapy if there is no bacterial growth, but also allow for tailoring of broad-spectrum therapy. Additionally, the use of antiobiograms improves empiric antibiotic selection based on local resistance patterns. However, execution of guideline recommendations has proved challenging. Understanding barriers in implementation is critical to developing targeted interventions aimed to improve adherence to these guidelines. The present study sought to investigate practice patterns and factors that influence urine testing and antibiogram use in the setting of empiric antibiotic treatment of UTI in children to ultimately improve adherence to UTI management guidelines. A random, national sample of physicians caring for children was surveyed from the American Medical Association Masterfile. Participants were queried regarding practice type, length of time in practice, factors influencing urine testing, urine specimen collection method, and antibiogram utilization. Logistic regression was used to assess factors associated with use of urine testing, bagged specimens, and antibiograms. Of respondents who acknowledged contact by surveyors, 47% completed the survey (n=366). Most respondents (84%) obtain urinalysis and culture prior to treatment for UTI. Physicians report they would more likely order testing if the specimen were easier to collect (46%) and if results were available immediately (48%) (Table). Urine collection by bag was more common in circumcised boys (>30%) compared with girls (20%) and uncircumcised boys (20%) (P=0.02). The most common reasons for collection by bag were parental refusal for (49%) and difficulty with (42%) catheterization (Table). Of the 70% of respondents reporting antibiogram access (n=256), 50% report its use the majority of the time with empiric prescription (n=128). While most practitioners report following guidelines to obtain urine testing prior to antibiotic prescription for UTI, urine collection by bag is common. Additionally, <50% of practitioners adhere to guideline recommendations for empiric antibiotic selection based on local antibiograms. Interventions to improve adherence to UTI management guidelines should focus on (1) improving catheterization practices, (2) educating parents regarding the value of catheterization, and (3) incorporating local antibiograms into electronic medical records.

Bacteriological profile, antibiotic sensitivity pattern, and detection of extended?spectrum ?-lactamase in the isolates of urinary tract infection from children

Background: Appropriate use of antibiotic in children with urinary tract infection (UTI) is essential so as to curb the spread of drug-resistant organisms. Objectives: To study the bacteriological profile and antibiotic sensitivity pattern in children with UTI and to determine the prevalence of extended-spectrum ?-lactamase (ESBL) producers of Escherichia coli and Klebsiella species. Methods: This prospective study was conducted from October 2010 to September 2011. The children between age group of 3 and 14 years who attended Pediatric Department at a tertiary care hospital were included in the study. Single midstream urine specimen was collected from each patient with suspected UTI. Result: Out of 184 urine samples with suspected UTI, 122 children had culture-proven UTI. Of 122 cases, 81 (66.39%) cases were seen in females. The most common organism isolated was E. coli (50%) followed by Klebsiella pneumoniae (23.77%) and Enterococcus species (8.19%). E. coli, Klebsiella spp., Citrobacter freundii, and Proteus mirabilis responded better to nitrofurantoin (NIT) (76.8%). Ceftriaxone (79.12%), cefotaxime (74.8%), and cefixime (71.7%) showed higher sensitivity as compared to ceftazidime (63.4%) and cefoperazone (CPZ) (59.4%). Among aminoglycosides, amikacin (82.4%) had a better response as compared to gentamicin (64.6%). Out of 61 E. coli and 31 Klebsiella species, 35 (38.04%) were ESBL producers. The sensitivity of these organisms to imipenem was 100% with a good response to meropenem, CPZ-sulbactam, and piperacillin-tazobactam. Conclusion: E. coli and Klebsiella spp. were the most common isolates and many of them were ESBL producers. NIT seemed to be a reasonable alternative to cephalosporins for the treatment of UTIs in children. Carbapenems were found to be effective in ESBLs and non-ESBL producing uropathogens and can be considered as reserve drugs.

Urinary Tract Infections in Children: A Changing Paradigm

Purpose: To review the changing paradigms in the diagnosis, investigation and management of Urinary Tract Infections (UTIs) in children beyond the neonatal period. Methods: A literature search was done using PUBMED, EBSCO host database and GOOGLE SCHOLAR of all articles including reviews and guidelines on UTIs in children for the last ten years. A total of 2725 articles including review articles and guidelines published over the last 10 years were searched and reviewed. Results: UTIs are the second most common cause of serious bacterial infections in early childhood, thus placing a huge financial burden on the health budget. Despite increasing resistance to several first-line antibiotics, appropriate antibiotic treatment has almost eliminated mortality. Early guidelines advocated aggressive treatment and extensive imaging studies, particularly for the detection of serious ureteric reflex and kidney scarring. Treatment in the acute episode is aimed at eradication of bacteriuria and alleviation of symptoms. Long-term goals include prevention of recurrent attacks of UTIs, kidney scarring and correction of urological lesions that may predispose to recurrent infections. Although there is increasing evidence to show that long-term antimicrobial prophylaxis may be associated with a reduced risk of recurrent infection in selected groups of patients, but not renal scarring, more studies are needed to confirm this. Surgical intervention is now restricted to cases with severe vesicoureteric reflux and failed medical management with endoscopic surgery being increasingly used in most centres compared to open surgery. Conclusion: Following extensive research, a more tangible approach to UTIs is advocated providing for more judicious use of resources with reduced harm from procedures, without affecting outcome. This review addresses the diagnosis, management and treatment of UTIs in children beyond the neonatal period.

Prevalence of multidrug resistant pathogens in children with urinary tract infection: A retrospective analysis

Urinary tract infection (UTI) is one of the commonest medical problems in children. It can distress the child and may cause kidney damage. Prompt diagnosis and effective treatment can prevent complications in the child. But treatment of UTI in children has now become a challenge due to the emergence of multidrug resistant bacteria.

THE ROLE OF CEPHALOSPORINS IN URINARY TRACT INFECTIONS TREATMENT IN CHILDREN

The problem of effective diagnosis and treatment of acute urinary tract infection (UTI) remains relevant in connection with a high prevalence of this nosology and the growth of antibiotic resistance. The need to use of antibiotics in the treatment of acute UTI in children has no doubt. At the same time there are different opinions on duration, and route of administration of the antibiotics. It is not always possible to achieve the desirable effect after a long courses of antibiotic therapy, and duration of fever as a clinical marker of inflammation, was not significantly different in the appointment of oral and parenteral antibiotics. The effectiveness of treatment of acute urinary tract infections in young children depends not on the way of administration but on the dose that ensures the achievement of the minimum inhibitory concentration of the drug. Drugs of choice in patients with acute UTI are: inhibitor-protected aminopenicillins and cephalosporins of II and III generation. However, in children with acute UTI who received antibiotic therapy previously, as well as in suspected obstructive uropathy, the most likely causative agent is toxin-producing E. coli, which has a high degree of resistance to aminopenicillins, including protected. Therefore, the drugs of choice in this category of children should be the antibiotics of the cephalosporin group II–III generation.

Antibiotic resistance of urinary tract pathogens and evaluation of empirical treatment in Turkish children with urinary tract infections

The changing pattern of antimicrobial resistance in the causative microorganisms of urinary tract infection (UTI) in childhood is a growing problem. The aims of this study were to assess the resistance patterns of urinary isolates to commonly used antimicrobials and to evaluate the options for empirical treatment of UTI. A prospective cross-sectional analysis of bacteria isolated from children with UTI was performed between January 2003 and January 2004. Resistance to antibiotics was analysed in three age groups: Group I, ≤12 months; Group II, 13–60 months; and Group III, >60 months. A total of 165 urinary pathogens were isolated from 131 patients. Mean patient age was 63.7 ± 49.8 months. The most common causative agent was Escherichia coli (87% of cases) followed by Klebsiella pneumoniae (10%). Resistance to ampicillin (74.2%) and co-trimoxazole (61.3%) was significant in all isolates. Nitrofurantoin was the most active agent against E. coli (2.2% resistant isolates), followed by amikacin (4.9%), ceftriaxone (7.5%) and ciprofloxacin (12%). None of the isolates from Group I patients were resistant to ciprofloxacin and a low resistance rate (7.1%) was noted for amikacin. In Group II patients, none of the isolates were resistant to amikacin, and ceftriaxone was the second most suitable antibiotic (resistance rate 2.2%). In Group III patients, the lowest resistance rate was against nitrofurantoin (2.7%). In conclusion, we observed that the use of ampicillin and co-trimoxazole as a single agent for empirical treatment of a suspected UTI would not cover the majority of urinary pathogens in our region. Whilst amikacin, with a negligible resistance rate, was suitable in all age groups, gentamicin might still be useful as an empirical treatment of UTI in children aged >1 year. Nitrofurantoin could be included as a reasonable alternative in the empirical treatment of lower UTI in older children.

Treatment of urinary tract infection with gentamicin once or three times daily

To examine the safety and efficacy of once-daily (OD) gentamicin treatment compared with conventional 8-hourly dosing (TDS) for urinary tract infection (UTI). This was a prospective, randomized, controlled trial of children 1 mo to 13 y of age with presumed UTI. Children were randomly assigned to OD gentamicin 5 mg kg(-1) d(-1) or TDS gentamicin 6 mg kg(-1) d(-1) divided 8 hourly. Microbiological efficacy, nephrotoxicity, ototoxicity and renal scarring were assessed at the end of treatment. 210 patients with presumed UTI were recruited, of whom 172 were analysable (OD 84, TDS 88). The median age was 7 mo, 50% were male and 74% (n = 127) of patients had pyelonephritis. The majority of infections were due to Escherichia coli (n = 153, 89%), of which 9 (5.2%) were bacteraemic. Comparing the two groups, there was no significant difference in age, gender, duration of fever before admission, pyuria, nitrite positivity or initial total white blood cell count. All patients had negative urine cultures after 2-3 d of treatment, demonstrating 100% microbiological efficacy. There was no difference between the two groups in terms of ototoxicity, nephrotoxicity, duration of gentamicin treatment or time to fever defervescence. OD gentamicin is as efficacious as TDS gentamicin in the treatment of UTI in children, with no difference in ototoxicity and nephrotoxicity.

Treatment of urinary tract infection with gentamicin once or three times daily

Aim: To examine the safety and efficacy of once-daily (OD) gentamicin treatment compared with conventional 8-hourly dosing (TDS) for urinary tract infection (UTI). Methods: This was a prospective, randomized, controlled trial of children 1 mo to 13 y of age with presumed UTI. Children were randomly assigned to OD gentamicin 5 mg kg−1 d−1 or TDS gentamicin 6 mg kg−1 d−1 divided 8 hourly. Microbiological efficacy, nephrotoxicity, ototoxicity and renal scarring were assessed at the end of treatment. Results: 210 patients with presumed UTI were recruited, of whom 172 were analysable (OD 84, TDS 88). The median age was 7 mo, 50% were male and 74% (n= 127) of patients had pyelonephritis. The majority of infections were due to Escherichia coli (n= 153, 89%), of which 9 (5.2%) were bacteraemic. Comparing the two groups, there was no significant difference in age, gender, duration of fever before admission, pyuria, nitrite positivity or initial total white blood cell count. All patients had negative urine cultures after 2–3 d of treatment, demonstrating 100% microbiological efficacy. There was no difference between the two groups in terms of ototoxicity, nephrotoxicity, duration of gentamicin treatment or time to fever defervescence. Conclusion: OD gentamicin is as efficacious as TDS gentamicin in the treatment of UTI in children, with no difference in ototoxicity and nephrotoxicity.

Comparative Study of Cefixime Alone Versus Intramuscular Ceftizoxime Followed by Cefixime in the Treatment of Urinary Tract Infections in Children

Urinary tract infections (UTI) can cause acute morbidity and may result in severe problems, including hypertension and reduced renal function. Diagnosis of UTI is extremely important since prompt treatment may prevent damage. In the present study we compared the efficacy of oral cefixime to initial intramuscular ceftizoxime followed by cefixime for the treatment of UTI in children. Fifty-four children were studied. They were randomized to receive either oral cefixime 8 mg/kg/day for 10 days or initial intramuscular ceftizoxime (Cefızox) 50 mg/kg twice a day for 2 days followed by oral cefixime for 8 days. Treatment groups were comparable regarding age, sex, clinical, and laboratory findings. Escherichia coli was isolated from 80% of patients. Repeat urine cultures were sterile within 24 hours in all children. Cure rates were comparable in both groups (92% vs 86% at the end of treatment). No serious adverse effects were observed. We concluded that oral cefixime is a safe and effective alternative treatment.

Clinical guidelines and hospital discharges of children with acute urinary tract infections.

In order to evaluate the effect of the introduction of recent similar guidelines on the treatment of acute urinary tract infection (UTI) in children, and possible changes in its epidemiology, we analyzed the records of hospital discharge for acute UTI under the age of 15 years in England and Wales between 1979 and 1993 and in Finland between 1978 and 1994. Cases were defined by the ICD9 diagnostic codes 590.1 (acute pyelonephritis) and 599.0 (UTI, site not specified) for males and females according to three age groups (0-4, 5-9, and 10-14 years). We also compared the registry data on kidney transplants due to end-stage renal disease caused by recurrent pyelonephritis in the United Kingdom and Finland. In England the rate of attack of symptomatic UTI per 1,000 girls under 15 years increased from 0.74 (95% confidence interval 0.71-0.76) in 1987 to 1.32 (1.29-1.35) in 1993 (P < 0.001, test for trend). The respective figures for Finnish girls were 1.74 (1.62-1.86) in 1987 and 1.62 (1.51-1.74) in 1993 (P = 0.72). In English boys, the increase in the attack rate was from 0.38 (0.36-0.40) in 1987 to 0.70 (0.68-0.73) in 1993 (P < 0.001). In Finnish boys the respective figures were 0.74 (0.66-0.82) in 1987 and 0.88 (0.80-0.97) in 1993 (P < 0.02). The observed increases in the attack rates of UTI most probably relate to increased referral of acute UTI patients to hospitals for the recommended imaging studies rather than changing occurrence. Publication of guidelines for treatment of UTI in children, consolidating more-general awareness, may have contributed to this. The mean annual numbers of kidney transplants in the United Kingdom and Finland during 1989-1995 due to end-stage renal disease caused by pyelonephritis were of similar magnitude, i.e., 1.9 (1.6-2.3) transplants per million inhabitants in the United Kingdom and 2.8 (1.5-4.7) transplants per million inhabitants in Finland. The decreasing trend in these figures in both countries, although statistically significant only in the United Kingdom (P < 0.05, test for trend), suggests improved longterm outcome of these patients induced by better diagnosis and treatment of pyelonephritis and the diseases related to it, such as congenital malformations. According to our data, valid clinical guidelines are effective in changing clinical practice.

Cefetamet pivoxil in the treatment of acute urinary tract infections in children

The data from this multicenter comparison of oral cefetamet pivoxil (CAT) (10 and 20 mg/kg twice daily) and amoxicillin plus clavulanic acid (30 to 50 mg/kg/d, in three divided doses) in the treatment of acute (recurrent) urinary tract infections (UTIs) in children are reported. A total of 421 children (aged 2 months to 15 years) were treated for 7 to 10 days. At follow-up (day 28), there was bacteriologic success (eradication or reinfection) in 97% of those treated with CAT and in 93% of those treated with amoxicillin plus clavulanic acid. The overall cure rate was 97% for CAT and 93% for amoxicillin plus clavulanic acid. There was no difference in outcome between the two CAT dosages. With both drugs adverse events were gastrointestinal in nature. CAT is an appropriate drug for the treatment of acute UTIs in children, being at least as effective as amoxicillin plus clavulanic acid.