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[Treatment of pediatric outpatients with complicated urinary tract infections]
M M Pahl1, B Ejzenberg, S L Ragazzi
1Divisão de Pediatria, Hospital Universitário da Universidade de São Paulo.
Insights
This study shows that once-daily intramuscular ceftriaxone is effective for treating complicated urinary tract infections (UTI) in children. The antibiotic treatment demonstrated a 95% success rate in young patients with complex UTIs.
Area of Science:
- Pediatric infectious diseases
- Pharmacology and therapeutics
- Urology
Context:
- Complicated urinary tract infections (UTI) in children pose significant clinical challenges.
- Accurate diagnosis and effective antimicrobial therapy are crucial for preventing long-term sequelae.
- Evaluating novel or alternative treatment regimens is essential for optimizing pediatric UTI management.
Purpose:
- To assess the therapeutic efficacy of once-daily intramuscular ceftriaxone in treating complicated urinary tract infections (UTI) in outpatient pediatric patients.
- To determine the effectiveness and safety profile of this specific antibiotic regimen.
- To identify key patient characteristics and causative pathogens in this cohort.
Summary:
- A prospective study evaluated 40 children (median age 3 months) with complicated UTIs, characterized by factors like young age, toxicity, fever, urinary tract abnormalities, or lumbar pain.
- Radiological findings included vesicoureteral reflux (6 patients), urethral posterior valve (1), and neurogenic bladder (4).
- Escherichia coli was the predominant pathogen (30 patients), followed by Klebsiella (4) and Proteus (4). Once-daily intramuscular ceftriaxone (50-70 mg/kg for 8-10 days) achieved a 95% efficacy rate (38/40 patients), with one treatment failure and one symptomatic reinfection.
Impact:
- Once-daily intramuscular ceftriaxone offers a viable and effective alternative treatment option for complicated pediatric urinary tract infections.
- This regimen simplifies treatment administration and may improve adherence in outpatient settings.
- The findings contribute to evidence-based guidelines for managing complex pediatric UTIs, particularly in resource-limited settings.
Abstract:
In an open and prospective study involving outpatient children with complicated urinary tract infections (UTI), we evaluated the therapeutic efficacy of ceftriaxone administered intramuscularly, once-daily--50 to 70 mg/kg, during 8 to 10 days. Initially, the selected patients exhibited at least two of the following clinical criteria: age below 6 months, any degree of toxicity, fever, strong suspicion or proved abnormalities of their urinary tracts and lumbar pain in children older than 4 years. Significant bacteriuria was demonstrated by urine culture in 40 patients (21 boys, 19 girls), whose ages ranged from 15 days to 6 years 9 months (median 3 months). The radiological studies revealed vesicoureteral reflux in 6 patients, urethral posterior valve in 1, and neurogenic bladder in 4. The main causative agents were Escherichia coli isolated in 30 patients, Klebsiella (4) and Proteus (4). The treatment was found to be effective in 38 patients (95%). There was failure of treatment in 1 patient and a symptomatic reinfection in another one. It was concluded that children with complicated UTI could be treated alternatively by once daily ceftriaxone.
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