Aztreonam in the treatment of severe urinary tract infections in pediatric patients
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Aztreonam effectively treated severe pediatric urinary tract infections caused by resistant Enterobacteriaceae. This antibiotic demonstrated good efficacy and safety in young patients with complex infections.
Area of Science:
- Clinical Pharmacology
- Infectious Diseases
- Pediatric Medicine
Background:
- Severe urinary tract infections (UTIs) in pediatric patients often involve multidrug-resistant Gram-negative bacteria.
- Ampicillin-resistant Enterobacteriaceae and Pseudomonas aeruginosa pose significant treatment challenges in pediatric UTIs.
- Limited effective and safe therapeutic options exist for complicated pediatric UTIs.
Purpose of the Study:
- To evaluate the efficacy and safety of aztreonam in treating severe UTIs in pediatric patients.
- To assess the pharmacokinetic profile of aztreonam in children with normal and impaired renal function.
- To determine the effectiveness of aztreonam against specific Gram-negative pathogens resistant to other antibiotics.
Main Methods:
- Aztreonam was administered intramuscularly to 30 pediatric patients (0.03–15.4 years) with severe UTIs.
- Dosing was adjusted based on renal function in four patients with renal insufficiency.
- Pharmacokinetic analysis was conducted in 13 patients (6 normal renal function, 7 with insufficiency).
Main Results:
- Clinical cure and urine sterilization were achieved in 22 out of 30 patients.
- Treatment failure occurred in two patients with P. aeruginosa and P. mirabilis infections.
- Transient laboratory alterations (eosinophilia, elevated hepatic enzymes, prolonged prothrombin time, neutropenia) were observed; no adverse clinical effects reported.
Conclusions:
- Aztreonam is an effective and safe treatment option for severe pediatric UTIs caused by susceptible Enterobacteriaceae.
- The drug's elimination half-life is inversely correlated with glomerular filtration rate, necessitating dose adjustments in renal insufficiency.
- Aztreonam demonstrated good clinical outcomes despite the presence of urological malformations and resistant pathogens.
Abstract:
Aztreonam was administered to 30 patients, ages 0.03 to 15.4 years, with severe and in 21 cases complicated urinary tract infections caused by members of the family Enterobacteriaceae and Pseudomonas aeruginosa which were resistant to ampicillin and susceptible to the study drug in vitro. A mean dose of 47.7 mg/kg was given intramuscularly every 12 h to 26 patients. In four patients with renal insufficiency, the dose was reduced according to pharmacokinetic data. Permanent urine sterilization and clinical cure were achieved in 22 patients, 13 of whom had urological malformations. In two patients with P. aeruginosa and Proteus mirabilis infections, the treatment failed. Another patient had an Escherichia coli reinfection 21 days after the end of therapy. Four patients with various urological abnormalities had gram-positive superinfections, and two patients had gram-negative superinfections during and at the end of therapy: all six had indwelling ureteric splints or pyelostomy as predisposing conditions. No adverse clinical effects were observed. Some transient and slight or moderate alterations were observed at the end of treatment: eosinophilia (nine cases), elevation of hepatic enzymes (eight cases), prolongation of prothrombin time (three cases), and neutropenia (one case). A pharmacokinetic study was performed in six patients with normal renal function and in seven patients with various degrees of renal insufficiency. The elimination half-life of the drug was inversely correlated with the glomerular filtration rate. At the dosage used, aztreonam proved effective for severe urinary tract infections caused by members of the family Enterobacteriaceae in pediatric patients.