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Published on: July 18, 2017
Best oral empirical treatment for pyelonephritis in children: Do we need to differentiate between age and gender?
Petra Salomonsson1, Marie-Louise von Linstow2, Jenny Dahl Knudsen3
1a Department of Paediatrics , Copenhagen University Hospital Hvidovre , Copenhagen , Denmark ;
Insights
Piv-mecillinam and amoxicillin-clavulanate are effective oral treatments for first-time childhood pyelonephritis in children over six months. Consider patient age and gender for optimal empirical antibiotic selection.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Renal health in children
Background:
- Pyelonephritis is a frequent childhood infection with potential for renal scarring.
- Effective oral antibiotic therapy is crucial for treating first-time pediatric pyelonephritis.
Purpose of the Study:
- To identify effective oral antibiotic treatments for first-time pyelonephritis in children.
- To analyze pathogen prevalence and antimicrobial susceptibility in pediatric urinary tract infections.
Main Methods:
- Retrospective analysis of urine cultures from 378 children (0-15.9 years) with first-time pyelonephritis.
- Evaluation of urine pathogens and their antimicrobial susceptibilities.
- Exclusion of patients with known renal anomalies.
Main Results:
- Escherichia coli was the predominant pathogen (85%), more common in girls and older children (>6 months).
- Younger children (<6 months) showed a higher prevalence of other Gram-negative rods.
- Piv-mecillinam and amoxicillin-clavulanate exhibited the lowest resistance rates (approx. 7%).
Conclusions:
- Piv-mecillinam or amoxicillin-clavulanate are recommended for empirical treatment of pyelonephritis in Danish children aged 6 months and older.
- Empirical antibiotic choice should account for patient age and gender.
- This aids in preventing antibiotic resistance and improving treatment outcomes.
Background:
Pyelonephritis is a common infection in childhood and may cause renal scarring. The aim was to determine an effective oral antibiotic treatment of first time pyelonephritis in children.
Methods:
The study is a retrospective analysis of positive urine cultures collected at a Danish paediatric department from 2010-2013. Urine samples from 378 children aged 0-15.9 years, without renal anomalies and treated for first time pyelonephritis, were included. The urine pathogens and antimicrobial susceptibilities were analysed.
Results:
The most common aetiologic agents found were Escherichia coli (85%), Klebsiella species and other Enterobacteriaecea (9.7%) and Enterococcus species (5.3%). Escherichia coli was significantly more common in girls than in boys (90% vs 74%, p < 0.001) and in children older than 6 months (89% vs 77%, p < 0.001). Children younger than 6 months had a higher prevalence of other Gram-negative rods (16% vs 7%, p < 0.001). These differences may be due to boys representing 63% of patients in the youngest age group compared to 16% of older children (p < 0.001). For all urine isolates, piv-mecillinam and amoxicillin-clavulanate had the lowest resistance rates of 6.9% and 7.2%, respectively, and 6% for both antimicrobials in patients older than 6 months. Uropathogens from boys above 6 months of age were more resistant to piv-mecillinam compared to girls (25% vs 2.4%, p < 0.001).
Conclusion:
This study recommends piv-mecillinam or amoxicillin-clavulanate as empirical treatment of first time pyelonephritis in Danish children from 6 months of age. Age and gender of patients should be taken into consideration when initiating empirical treatment.
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