Related Experiment Video
Updated: Jul 15, 2025
Recurrent Escherichia coli Urinary Tract Infection Triggered by Gardnerella vaginalis Bladder Exposure in Mice
Published on: December 4, 2020
Antibiotic Prescribing Practices for Urinary Tract Infection in a Pediatric Emergency Department: Is This a Problem
Jordan Kelly1, Trevor Toy2, Deonne Dersch-Mills1
1PharmD, is with Pharmacy Services, Alberta Health Services, Calgary, Alberta.
Insights
Cephalexin or nitrofurantoin effectively treated most pediatric lower urinary tract infections (UTIs). Optimal antibiotic selection for upper UTIs requires further investigation, as current treatment durations often exceed guidelines.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Clinical Microbiology
Background:
- Pediatric urinary tract infections (UTIs) present significant diagnostic and therapeutic challenges.
- Optimizing antibiotic selection is crucial for effective treatment and preventing resistance.
Purpose of the Study:
- To identify the least-broad-spectrum oral antibiotic covering 80% of pathogens causing lower and upper UTIs in Canadian pediatric emergency departments.
- To inform evidence-based antibiotic prescribing for pediatric UTIs.
Main Methods:
- Retrospective case series of children diagnosed with UTI and treated with oral antibiotics.
- Analysis of urine culture results and antibiotic susceptibility patterns.
- Inclusion of patients discharged from a Canadian pediatric emergency department between September 2020 and February 2021.
Main Results:
- Cephalexin (85.3%) and nitrofurantoin (80.0%) demonstrated high susceptibility for lower UTI pathogens.
- Cefixime (94.7%) and trimethoprim-sulfamethoxazole (76.0%) showed good coverage for upper UTI pathogens.
- Mean antibiotic duration was 8.3 days for lower UTIs and 9.1 days for upper UTIs, with lower UTIs often treated longer than recommended.
Conclusions:
- Cephalexin or nitrofurantoin are suitable empiric choices for most pediatric lower UTIs.
- Further data on cephalexin's minimal inhibitory concentrations could guide its use in upper UTIs.
- Current antibiotic treatment durations for pediatric UTIs, particularly lower UTIs, may exceed guideline recommendations.
Background:
Pediatric urinary tract infection (UTI) is associated with diagnostic and therapeutic challenges.
Objective:
To determine the least-broad-spectrum oral antibiotic that would cover 80% of pathogens from lower (afebrile) and upper (febrile) UTIs in a Canadian pediatric emergency department (ED).
Methods:
This retrospective case series involved children discharged from the ED between September 2020 and February 2021 with a diagnosis of UTI and collection of a sample for urinalysis that had growth on culture.
Results:
Of 188 patients who met the inclusion criteria, 184 (97.9%) were discharged on antibiotics. Culture results indicated a UTI in 170 cases (92.4% of those discharged on antibiotics). The 95 urinary isolates from lower UTIs were susceptible to cephalexin (n = 81, 85.3%), cefixime (n = 78, 82.1%), nitrofurantoin (n = 76, 80.0%), trimethoprim-sulfamethoxazole (TMP-SMX) (n = 64, 67.4%), and amoxicillin (n = 55, 57.9%). The 75 urinary isolates from upper UTIs were susceptible to cefixime (n = 71, 94.7%), TMP-SMX (n = 57, 76.0%), and amoxicillin (n = 48, 64.0%). The mean prescribed duration of antibiotic therapy was 8.3 days for patients with a lower UTI and 9.1 days for those with an upper UTI (mean difference 0.80 days, 95% confidence interval 0.05-1.54).
Conclusions:
Empiric treatment with cephalexin or nitrofurantoin would have been successful for almost all lower UTIs. More complete reporting of cephalexin minimal inhibitory concentrations might have allowed use of this drug for most upper UTIs. Although there was a trend toward shorter duration of therapy for lower versus upper UTI, lower UTIs were always treated for longer than recommended by current guidelines.
Related Concept Videos
01:30Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care
01:17Urinary Tract Infection IV: Nursing Management
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
01:26Urine Studies II: Urine Culture and Sensitivity Test
01:26Urinary Tract Infection I: Introduction
01:27Acute Pyelonephritis I: Introduction