Piperacillin-Tazobactam versus Cefotaxime as Empiric Treatment for Febrile Urinary Tract Infection in Hospitalized
Kyoung Hee Han1, Min-Su Oh1, Jungmin Ahn1
1Department of Pediatrics, Jeju National University College of Medicine and Jeju National University Hospital, Jeju, Korea.
Insights
Piperacillin-tazobactam (TZP) is a viable alternative to cefotaxime (CTX) for treating pediatric urinary tract infections (UTIs) in hospitalized children aged 3 months and older in Korea, where antibiotic resistance is high.
Area of Science:
- Pediatric Infectious Diseases
- Antimicrobial Stewardship
- Clinical Pharmacology
Background:
- International guidelines recommend ampicillin/sulbactam or amoxicillin/clavulanate for pediatric urinary tract infections (UTIs).
- High resistance rates to these agents in Korea necessitate alternative empirical treatments.
- Third-generation cephalosporins are widely used, prompting investigation into other broad-spectrum options.
Purpose of the Study:
- To compare the efficacy of piperacillin-tazobactam (TZP) versus cefotaxime (CTX) as first-line treatments for hospitalized pediatric UTIs in Korea.
- To evaluate treatment response, recurrence rates, and antimicrobial susceptibility patterns.
Main Methods:
- Retrospective analysis of medical records of children hospitalized with febrile UTIs from 2014-2017.
- Inclusion criteria: unexplained fever, abnormal urinalysis, and confirmed uropathogens.
- Comparison of outcomes between patients treated with TZP and CTX.
Main Results:
- 220 out of 323 patients met inclusion criteria; groups were comparable.
- No significant differences in treatment response or recurrence were observed between TZP and CTX for children aged ≥3 months.
- Extended-spectrum beta-lactamase (ESBL)-positive strains were linked to recurrence in children <3 months.
Conclusions:
- Piperacillin-tazobactam (TZP) is a suitable alternative to cefotaxime (CTX) for hospitalized pediatric UTIs in children aged ≥3 months in Korea.
- Individualized treatment strategies are essential for younger children (<3 months), especially when extended-spectrum beta-lactamase (ESBL)-producing organisms are suspected.
Background:
According to international pediatric urinary tract infection (UTI) guidelines, selecting ampicillin/sulbactam or amoxicillin/clavulanate is recommended as the first-line treatment for pediatric UTI. In Korea, elevated resistance to ampicillin and ampicillin/sulbactam has resulted in the widespread use of third-generation cephalosporins for treating pediatric UTIs. This study aims to compare the efficacy of piperacillin-tazobactam (TZP) and cefotaxime (CTX) as first-line treatments in hospitalized children with UTIs.
Materials And Methods:
The study, conducted at Jeju National University Hospital, retrospectively analyzed medical records of children hospitalized for febrile UTIs between 2014 and 2017. UTI diagnosis included unexplained fever, abnormal urinalysis, and the presence of significant uropathogens. Treatment responses, recurrence, and antimicrobial susceptibility were assessed.
Results:
Out of 323 patients, 220 met the inclusion criteria. Demographics and clinical characteristics were similar between TZP and CTX groups. For children aged ≥3 months, no significant differences were found in treatment responses and recurrence. Extended-spectrum beta-lactamase (ESBL)-positive strains were associated with recurrence in those <3 months.
Conclusion:
In Korea, escalating resistance to empirical antibiotics has led to the adoption of broad-spectrum empirical treatment. TZP emerged as a viable alternative to CTX for hospitalized children aged ≥3 months with UTIs. Consideration of ESBL-positive strains and individualized approaches for those <3 months are crucial.
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