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Oxolinic acid therapy for urinary tract infections in children
Insights
Oxolinic acid effectively treated urinary tract infections in children, with favorable responses in most cases. However, resistance can develop, necessitating monitoring and potential re-testing of antibiotic susceptibility.
Area of Science:
- Pediatric infectious diseases
- Pharmacology and therapeutics
Background:
- Urinary tract infections (UTIs) are common in children, often caused by Gram-negative bacteria.
- Oxolinic acid is an antibiotic used for bacterial infections.
Purpose of the Study:
- To evaluate the efficacy and safety of oxolinic acid in treating hospitalized children with Gram-negative bacillary UTIs.
- To assess the development of bacterial resistance during oxolinic acid therapy.
Main Methods:
- A cohort of 30 hospitalized children with Gram-negative bacillary UTIs received oxolinic acid for 14-21 days.
- Bacteriologic response, development of resistance, and adverse events were monitored.
- Urine concentrations of oxolinic acid were measured and compared to minimal inhibitory concentrations (MICs).
Main Results:
- Favorable bacteriologic responses were observed in 15/17 uncomplicated UTIs and 11/13 complicated UTIs.
- Bacterial resistance to oxolinic acid emerged in four treatment failures.
- Mild, transient symptoms possibly related to oxolinic acid occurred in about half the patients.
Conclusions:
- Oxolinic acid demonstrates efficacy in treating pediatric Gram-negative bacillary UTIs, but resistance can develop.
- Monitoring for treatment failure by day five is crucial; if the urine is not sterile, re-evaluation of antibiotic susceptibility is recommended.
Abstract:
Thirty hospitalized children with Gram-negative bacillary urinary tract infections were treated with oxolinic acid for 14 to 21 dyas. Fifteen of 17 patients with uncomplicated and 11 of 13 with complicated urinary infections had favorable bacteriologic responses. Resistant organisms developed in four treatment failures. Oxolinic acid urine concentrations were well above the minimal inhibitory concentration for most strains of Escherichia coli, Klebsiella, Enterobacter, Proteus mirabilis, P vulgaris, P morganii, and P rettgeri. Approximately half of these patients experienced mild symptoms possibly related to oxolinic acid therapy; in no instance did they require cessation of therapy. Our experience indicates that if the urine is not sterile by the end of five days of treatment, bacterial resistance to oxolinic acid is likely to have developed, and therapy with another agent should be considered and antibiotic susceptibility tests repeated.