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Is combination antimicrobial therapy required for urinary tract infection in children?
Kun-Chia Lu1, Po-Yen Chen, Fang-Liang Huang
1Department of Pediatrics, Taichung Veterans General Hospital, Taiwan, ROC.
Insights
First-generation cephalosporins are effective for pediatric urinary tract infections (UTIs). This study found them superior to other first-line agents, suggesting combination therapy is best reserved for severe cases.
Area of Science:
- Pediatric infectious diseases
- Clinical microbiology
- Pharmacology
Background:
- Urinary tract infections (UTIs) are common in children.
- Antibiotic resistance necessitates evaluating effective treatment strategies.
- Escherichia coli is the predominant pathogen in pediatric UTIs.
Purpose of the Study:
- To evaluate the efficacy of first-generation cephalosporins in treating pediatric community-acquired urinary tract infections.
- To compare the effectiveness of different antibiotic regimens for pediatric UTIs.
- To determine optimal antibiotic strategies for pediatric UTI management.
Main Methods:
- Retrospective analysis of 338 pediatric patients with symptomatic UTIs.
- Categorization of patients into treatment groups based on antibiotic regimens.
- Comparison of susceptibility rates and defervescence times among treatment groups.
Main Results:
- First-generation cephalosporins demonstrated higher susceptibility rates compared to other first-line agents.
- Cefazolin or cephalexin monotherapy showed a 95% susceptibility rate with an average defervescence of 2.1 days.
- Switching from ampicillin plus gentamicin to cefazolin alone improved susceptibility in non-responsive cases (62.5%).
Conclusions:
- First-generation cephalosporin monotherapy is an appropriate treatment for pediatric community-acquired UTIs.
- Antimicrobial combinations should be reserved for severe or critical pediatric UTI cases.
- Empiric antibiotic selection impacts treatment outcomes in pediatric UTIs.
Abstract:
This retrospective study examined the characteristics of 338 pediatric patients presenting with a first episode of symptomatic urinary tract infection at Taichung Veterans General Hospital from November 1996 to December 2001. Escherichia coli was the most common pathogen (72.5%), followed by Proteus mirabilis (8.3%), Enterococcus (5.6%), and Klebsiella pneumoniae (4.7%). They were more susceptible to first-generation cephalosporin in comparison with other first-line antimicrobial agents such as trimethoprim/sulfamethoxazole, ampicillin, and gentamicin. Two hundred and eighty-seven (84.9%) of the 338 patients were divided into 3 groups according to the type of antibiotic treatment received, and the susceptibility rate and the averaged day of defervescence after effective antibiotic therapy were compared among the groups. Group 1 consisted of those patients treated with cefazolin or cephalexin alone (95%, 2.1 days); Group 2, cefazolin plus gentamicin (88.9%, 2.8 days); and Group 3, ampicillin plus gentamicin (76.1%, 2.3 days). A total of 38 (13.2%) cases from the 3 antibiotic groups did not respond to empiric antibiotics. For non-susceptible infections, when the antibiotic regimen was switched from cefazolin plus gentamicin to ampicillin alone, only 4 (20%) strains became susceptible, compared with 10 strains (62.5%) becoming susceptible after switching from ampicillin plus gentamicin to cefazolin alone (p < 0.01). The results indicated that first-generation cephalosporin alone is an appropriate treatment for pediatric cases of community-acquired urinary tract infection and suggest that antimicrobial combinations should be reserved for serious or critical cases.