Approximately 7 to 8% of girls and 2% of boys have a UTI during the first 8 years of life. Not all UTIs involve the kidney, but acute pyelonephritis is one of the most common serious bacterial infections in children. Our latest Medical Progress review, Febrile Urinary Tract Infections in Children, summarizes diverse views on this topic.
Acute pyelonephritis is the most common serious bacterial infection in childhood; many affected children, particularly infants, have severe symptoms.
Clinical Pearls
• When is hospitalization indicated for children with febrile urinary tract infections?
The American Academy of Pediatrics (AAP) currently recommends that parenteral antibiotic therapy and hospitalization be considered for children who appear “toxic” or dehydrated or who are unable to retain oral intake. The AAP suggests considering outpatient parenteral antibiotics when a child is vomiting but does not appear “toxic,” or when nonadherence is a concern.
• Should children with febrile urinary tract infection be imaged to detect reflux?
The best approach to evaluating a child after a first febrile urinary tract infection remains a contentious issue. Because the presence and severity of reflux can be reliably determined only by means of voiding cystography, some advocate performing cystography in all children after a first febrile urinary tract infection. A more selective approach suggests performing voiding cystourethrography if a child has a first febrile urinary tract infection with atypical features — such as abnormalities on antenatal or postnatal ultrasonographic examination, infection with non-E. coli organisms, abnormal urine stream, or evident renal dysplasia or renal insufficiency — or if a child with a repeat febrile urinary tract infection did not undergo a voiding study after the initial episode.
Morning Report Questions
Q: Which children with a history of febrile urinary tract infection should receive antibiotic prophylaxis?
A: On the basis of the studies reviewed here, the authors suggest that the role of prophylaxis is questionable in children with no reflux or with grade I or II reflux, given a recurrence rate for infection of 3 to 8% per year without prophylaxis. For children with grade III to V reflux, who have a much higher rate of reinfection (28 to 37%), prophylaxis would seem appropriate, particularly in girls.
Q: What antibiotic treatment is recommended for a child with a first acute urinary tract infection?
A: The choice of antibiotics for acute urinary tract infections depends on resistance patterns in a given institution or region.
Cephalosporins and amoxicillin-clavulanate are the oral antibiotics most often used. Ciprofloxacin is a second choice for the treatment of complicated urinary tract infections; there is increasing resistance to ciprofloxacin and it has been associated with an increased risk of musculoskeletal adverse events. Azithromycin and metronidazole are not the most often used antibiotics for this indication.
Cefalosporins is our pediatrician’s first oral choice, not augmenting
In PH, Nigeria, Cephalosporin, is the drug of choice now.
what is the best drug for oral prescription regarding antimicrobial spectrum cefixime or ceftibuten