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Single-dose amikacin treatment of first childhood E. coli lower urinary tract infections
Insights
Single-dose amikacin is as effective as a 10-day sulfisoxazole course for treating first-time Escherichia coli lower urinary tract infections in girls. This approach offers potential benefits like improved compliance and fewer side effects.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pharmacology
Background:
- Urinary tract infections (UTIs) in children typically require 10-14 days of oral antibiotics.
- Poor patient compliance with prolonged antibiotic regimens is a common challenge.
- Single-dose aminoglycoside therapy has shown promise for treating cystitis in adult women.
Purpose of the Study:
- To evaluate the efficacy of a single intramuscular dose of amikacin compared to a 10-day oral course of sulfisoxazole for treating first episodes of Escherichia coli lower UTIs in girls.
- To assess the potential advantages of single-dose therapy, including compliance and reduced side effects.
Main Methods:
- A randomized study involving 54 girls (ages 1-12) with confirmed E. coli UTIs.
- Participants received either a single intramuscular dose of amikacin (7.5 mg/kg) or oral sulfisoxazole (150 mg/kg/day) for 10 days.
- Infections were presumptively categorized as upper or lower UTI based on clinical criteria.
Main Results:
- Recurrence of positive urine cultures within 40 days occurred in 26% of the amikacin group (6/23) and 19% of the sulfisoxazole group (4/21).
- The difference in recurrence rates between the two treatment groups was not statistically significant (P > 0.5).
Conclusions:
- Single-dose intramuscular amikacin appears to be as effective as a 10-day oral course of sulfisoxazole for presumed first lower UTIs in girls.
- Single-dose therapy may offer advantages such as improved patient compliance, reduced side effects, and a lower potential for developing antibiotic resistance.
Abstract:
Urinary tract infection in children is usually treated with orally administered antibiotics for 10 to 14 days. Because of the unreliability of patient compliance with prescribed medications and because single-dose aminoglycoside therapy has been shown to be effective in women with cystitis, we assessed the efficacy of single-dose amikacin for treatment of first episodes of Escherichia coli lower urinary tract infection in girls. Upper and lower urinary tract infections were presumptively differentiated by simple criteria such as clinical symptoms, fever, and erythrocyte sedimentation rate. Fifty-four girls (ages 1 to 12 years) with two positive urine cultures (greater than 10(5) CFU/ml E. coli) were assigned by a table of random numbers to receive treatment with either sulfisoxazole 150 mg/kg/day orally for 10 days or a single dose of amikacin 7.5 mg/kg intramuscularly. Six of 23 patients (26%) in the amikacin group and four of 21 (19%) in the sulfisoxazole group had at least one positive urine culture within 40 days after completion of therapy. This difference was not statistically significant (P greater than 0.5). This suggests that a single dose of amikacin is as effective as a 10-day course of sulfisoxazole in the treatment of presumed first lower urinary tract infection in girls. Additional potential advantages of single-dose therapy are fewer side effects and less toxicity, excellent compliance, and reduced potential for selecting resistant organisms.