Related Experiment Videos
Urinary tract infections with tissue penetration in children: cefotaxime compared with amoxycillin/clavulanate
M Fischbach1, U Simeoni, L Mengus
1Service de Pédiatrie, Hôpital de Hautepierre, Strasbourg, France.
Insights
Comparing two urinary tract infection treatments in children, this study found that amoxicillin/clavulanate for seven days was as effective as cefotaxime for 14 days. Both regimens successfully treated infections with similar outcomes.
Area of Science:
- Pediatric infectious diseases
- Pharmacology and therapeutics
Background:
- Urinary tract infections (UTIs) in children often lack clear clinical localization.
- Assessing UTI severity and risk of renal scarring relies on clinical signs and lab markers of tissue penetration.
- Optimizing antibiotic therapy duration is crucial for children, considering venous access and hospitalization costs.
Purpose of the Study:
- To compare the efficacy and tolerance of two antibiotic regimens for pediatric UTIs with tissue penetration.
- To evaluate cefotaxime administered intravenously for 14 days versus amoxicillin/clavulanate for seven days (with oral switch).
Main Methods:
- A randomized study involving 20 children over one year old with UTIs.
- Group I received cefotaxime (100 mg/kg/d IV for 14 days).
- Group II received amoxicillin/clavulanate (100 mg/kg/d IV for 7 days, then 50 mg/kg/d orally for 7 days).
Main Results:
- Both treatment groups demonstrated identical clinical, bacteriological, and biological efficacy.
- Time to becoming afebrile, urine sterilization, and normalization of inflammatory markers were similar.
- Diarrhea was the only observed side effect, affecting three patients without treatment modification.
Conclusions:
- A seven-day course of intravenous then oral amoxicillin/clavulanate is as effective as a 14-day intravenous cefotaxime regimen for pediatric UTIs.
- Shorter intravenous antibiotic duration is feasible and effective, potentially reducing healthcare costs and improving patient management.
Abstract:
In children, the site of urinary tract infection (acute pyelonephritis or cystitis) cannot usually be accurately determined from the clinical presentation. The severity of the urinary tract infection (risk of renal scars) is best correlated with its estimated degree of tissue penetration clinically (fever, general condition) and on laboratory tests (sedimentation rate, C-reactive protein). The duration of parenteral antibiotic therapy, especially in children (taking account of difficult venous access and the cost of hospitalization) needs to be specified beyond the initial period required for sterilization of the urine (usually less than 48 h). We conducted a study in children older than one year to compare the efficacy and tolerance of two treatment regimens for urinary tract infection with tissue penetration: cefotaxime 100 mg/kg/d in four divided iv doses for 14 days (group I) and amoxycillin/clavulanate 100 mg/kg/d in four divided iv doses for seven days with conversion to the oral route at a dosage of 50 mg/kg/d for seven days (group II). The randomised protocol included ten patients in each group, comparable with respect to sex, age and history. Clinical efficacy (time until the patient became afebrile), bacteriological efficacy (sterilization of the urine), and biological efficacy (time to normalization of the indices of the acute inflammatory response) were identical for both groups regardless of the duration of iv antibiotic treatment (seven days for amoxycillin/clavulanate; 14 days for cefotaxime). The only side effect was diarrhoea, which affected three patients and did not require modification of the oral treatment regimen.(ABSTRACT TRUNCATED AT 250 WORDS)