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Ampicillin-sulbactam monotherapy in infants with febrile urinary tract infections
Ji Yeon Song1, Sukdong Yoo1, Taek Jin Lim1
1Department of Pediatrics, Pusan National University Children's Hospital, Yangsan, Korea.
Insights
Ampicillin-sulbactam is an effective alternative to cephalosporins for treating pediatric urinary tract infections (UTIs). This study found similar effectiveness and no significant differences in outcomes for children with UTIs treated with either antibiotic.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Clinical pharmacology
Background:
- Cephalosporins are common empirical treatments for pediatric urinary tract infections (UTIs).
- Rising cephalosporin use may increase resistant pathogens.
- Alternative empirical therapies are needed to combat antimicrobial resistance.
Purpose of the Study:
- To evaluate ampicillin-sulbactam as an alternative empirical therapy for first-episode febrile UTIs in young children.
- To compare the efficacy and safety of ampicillin-sulbactam versus cefotaxime in treating pediatric UTIs.
Main Methods:
- Retrospective study of 2- to 24-month-old children hospitalized with first-episode febrile UTI (2012-2014).
- Patients received either cefotaxime or ampicillin-sulbactam as empirical therapy.
- Pathogen identification, antibiotic susceptibility testing, and comparison of clinical outcomes and adverse events.
Main Results:
- Escherichia coli was the most common pathogen in both treatment groups.
- Antibiotic susceptibilities were similar between ampicillin-sulbactam and cefotaxime groups.
- No significant difference in fever duration (2.0 vs. 3.0 days) or treatment outcomes; diarrhea was the most common side effect.
Conclusions:
- Ampicillin-sulbactam demonstrates comparable efficacy to cefotaxime for empirical treatment of first-episode UTIs in children under 24 months.
- Ampicillin-sulbactam represents a viable alternative to cephalosporins, potentially aiding in antimicrobial stewardship efforts.
- Further research may explore broader applications and long-term outcomes of ampicillin-sulbactam in pediatric UTI management.
Background:
Cephalosporin is the most commonly used empirical agent for urinary tract infections (UTIs) in children. However, increasing use of cephalosporins can lead to an increase in resistant pathogens. This study therefore aims to investigate the effects of monotherapy with ampicillin-sulbactam as an alternative to cephalosporins.
Methods:
All 2- to 24-month-old patients who were hospitalized at Pusan National University Children's Hospital due to a first episode of a febrile UTI during the 2-year period from 2012 to 2014 were included in the study. The subjects were divided into two groups according to their empirical therapy (cefotaxime or ampicillin-sulbactam). We determined the patients' UTI pathogens and their antibiotic susceptibilities and compared the effectiveness and the occurrence of adverse effects of ampicillin-sulbactam and cephalosporin therapy.
Results:
Forty-six patients were treated with cefotaxime (group A) and 41 patients with ampicillin-sulbactam as the empirical antibiotic (group B). The most common pathogen in both groups was Escherichia coli, and antibiotic susceptibilities of the bacterial strains isolated from both groups were similar in ampicillin-sulbactam and cefotaxime. In addition, there was no significant difference in the duration of fever after treatment between the two groups (group A: 2.0 versus group B: 3.0, P = 0.331). There were no treatment failures and no recurrence in either group, even in patients with resistant pathogens. The most common side effect of the antibiotic agents was diarrhea.
Conclusions:
Ampicillin-sulbactam could be an effective alternative to cephalosporin as empiric antibiotic for the treatment of first-episode UTI in patients under 24 months of age.
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