Antimicrobial treatment of urinary tract infections in children

Area of Science:

• Pediatrics
• Infectious Diseases
• Microbiology

Background:

• Urinary tract infections (UTIs) are the most common bacterial infections in children.
• Extended-spectrum ß-lactamase-producing Escherichia coli (E-ESBL) pose a treatment challenge due to rising resistance.
• Current treatment guidelines are based on recommendations from the Groupe de Pathologie Infectieuse de Pédiatrique (GPIP-SFP).

Purpose of the Study:

• To provide updated treatment recommendations for pediatric UTIs.
• To address the challenge of E-ESBL infections in children.
• To favor outpatient management and avoid broad-spectrum antibiotics like penems.

Main Methods:

• The guide is based on existing recommendations from GPIP-SFP.
• It emphasizes the importance of urine dipstick tests preceding urine cultures and antibiotic therapy, except in specific cases.
• It proposes amikacin as a preferred initial treatment for febrile UTIs, including suspected or confirmed E-ESBL infections.

Main Results:

• The proportion of E-ESBL resistant E. coli strains in pediatrics has remained stable between 7% and 10% since 2012.
• Many oral antibiotics are ineffective against E-ESBL, necessitating parenteral treatment or non-standard combinations.
• Amikacin demonstrates activity against the majority of E-ESBL strains.

Conclusions:

• Amikacin is favored for initial treatment of febrile UTIs in pediatric patients, including those with E-ESBL infections.
• This approach aims to avoid penem antibiotics and facilitate outpatient management.
• Amikacin can be used as monotherapy in emergency departments or for hospitalized pediatric patients.