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Published on: June 24, 2025
Antimicrobial treatment of urinary tract infections in children
R Cohen1, J Raymond2, E Launay3
1Université Paris Est, IMRB-GRC GEMINI, 94000 Créteil, France; Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, Centre Hospitalier Intercommunal de Créteil, France; Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), Saint-Maur des Fossés, France; Groupe de Pathologie Infectieuse Pédiatrique de la Société Française de Pédiatrie (GPIP), Saint-Maur des Fossés, France.
Insights
Pediatric urinary tract infections (UTIs) require careful antibiotic selection. Amikacin is proposed as an initial treatment for febrile UTIs in infants, offering activity against resistant strains and enabling outpatient care.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Urinary tract infections (UTIs) are common bacterial infections in children.
- Rising rates of extended-spectrum β-lactamase (ESBL) producing *Escherichia coli* complicate treatment.
- Decreasing availability of oral antibiotic switch options necessitates alternative strategies.
Purpose of the Study:
- To propose updated antibiotic guidelines for pediatric UTIs.
- To address the challenge of increasing antimicrobial resistance.
- To promote outpatient management and preserve broad-spectrum antibiotics.
Main Methods:
- Antibiotic recommendations based on Pediatric Infectious Disease Group (GPIP) and French-Language Infectious Disease Society (SPILF) guidelines.
- Emphasis on urine dipstick testing preceding culture and antibiotics (with exceptions).
- Evaluation of amikacin as an initial treatment option for febrile UTIs in infants.
Main Results:
- Cephalosporin resistance in France remains below 10% but is expected to rise.
- Amikacin demonstrates activity against most ESBL strains.
- Once-daily dosing of amikacin facilitates ambulatory care.
Conclusions:
- Amikacin is a viable initial treatment for febrile UTIs in infants, particularly those caused by ESBL-producing bacteria.
- This approach aids in preserving other antibiotic classes and supports outpatient management.
- Adherence to updated guidelines is crucial for effective pediatric UTI treatment.
Abstract:
Urinary tract infections are the most frequent documented bacterial infections in children. The antibiotic choices proposed in this manuscript are based on the guidelines published by the Pediatric Infectious Disease Group (GPIP) and the French-Language Infectious Disease Society (SPILF). Dipstick positive for leukocytes and/or nitrites must precede in most circumstances (excluding the newborns, neutropenic patients and those with sepsis), urine culture and antibiotic prescription. The proportion of extended-spectrum β-lactamase (ESBL) Escherichia coli strains has increased steadily in recent years, and the situations in which oral antibiotic switch is frequently not available are increasing. Cephalosporin resistance remains below 10% in most regions of France. However, there is no doubt that the proportion of resistant strains will increase in the coming years: the only uncertainly concerns the speed of this trend. With the aim of saving penems and promoting outpatient care, this guide proposes among the acceptable initial treatments for febrile urinary tract infections in infants, amikacin. This aminoglycoside remains active against the majority of ESBL strains and can be prescribed in once-daily dose allowing also ambulatory management of patients from pediatric emergency department.
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