Validation of Cefazolin as Initial Antibiotic for First Upper Urinary Tract Infection in Children

Area of Science:

• Pediatric Infectious Diseases
• Antibiotic Stewardship
• Clinical Pharmacology

Background:

• Febrile urinary tract infections (UTIs) are common in children.
• Cefazolin (CEZ) is a commonly used first-line antibiotic for pediatric UTIs.
• Evaluating CEZ efficacy and microbial susceptibility is crucial for optimizing treatment guidelines.

Purpose of the Study:

• To validate the use of cefazolin (CEZ) as a first-line antibiotic for children hospitalized with their first febrile UTI.
• To assess microbial susceptibility patterns to CEZ in this patient population.
• To determine the clinical efficacy of CEZ in treating pediatric febrile UTI.

Main Methods:

• A prospective study involving 75 children hospitalized with their first febrile UTI.
• Initial treatment with cefazolin (CEZ).
• Monitoring for treatment effectiveness, fever duration, bacteremia, pathogen resistance (ESBL-producing E. coli), and hospitalization duration.

Main Results:

• Cefazolin (CEZ) treatment was successful without requiring a switch in 84% of pediatric patients.
• Higher fever duration, bacteremia rates, ESBL-producing E. coli prevalence, and hospitalization were observed in the CEZ-ineffective group.
• No increased risk of vesicoureteral reflux, surgical indication, or renal scarring was associated with CEZ use, even when ineffective.

Conclusions:

• Cefazolin (CEZ) demonstrates high effectiveness (>80%) for first febrile UTIs in children.
• Antibiotic therapy should be switched if fever persists beyond 72 hours or if sepsis or ESBL-producing Enterobacteriaceae are suspected.
• CEZ remains a valuable first-line option, but careful monitoring and timely adjustments are essential for managing pediatric febrile UTIs.