Antibiotics for acute pyelonephritis in children

Hodson, Elisabeth M; Willis, Narelle S; Craig, Jonathan C.

doi:10.1002/14651858.cd003772.pub3

Cited by 79 publications

(62 citation statements)

References 59 publications

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“…However, a more recent meta-analysis evaluating different antibiotic regimens for acute pyelonephritis in children found that there was no difference in the effectiveness of oral therapy with thirdgeneration cephalosporins compared with amoxicillin-clavulanate. 2 Moreover, third-generation cephalosporins may no longer offer the assured antimicrobial coverage for patients with complicated UTIs that they once did. Lutter et al 21 reported that children receiving antimicrobial prophylaxis with breakthrough UTIs were often infected with an organism resistant to thirdgeneration cephalosporins, despite the fact that none of these children were taking cephalosporin prophylaxis.…”

Section: Summary Of Findingsmentioning

confidence: 99%

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National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

Copp¹,

Shapiro

Hersh

2011

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT:Urinary tract infections represent a significant source of exposure to antibiotics in the pediatric population and often physicians must select the antibiotic treatment empirically. No examination of ambulatory antibiotic prescribing patterns in the United States for children with urinary tract infections has been performed. WHAT THIS STUDY ADDS:Ambulatory care physicians commonly prescribe broad-spectrum antibiotics, especially third-generation cephalosporins, for the treatment of pediatric urinary tract infections. Given that narrower-spectrum alternatives are frequently appropriate options for the treatment of these infections, efforts are necessary to promote more judicious antibiotic prescribing for pediatric urinary tract infections.abstract OBJECTIVE: The goal of this study was to investigate patterns of ambulatory antibiotic use and to identify factors associated with broad-spectrum antibiotic prescribing for pediatric urinary tract infections (UTIs). METHODS:We examined antibiotics prescribed for UTIs for children aged younger than 18 years from 1998 to 2007 using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey. Amoxicillin-clavulanate, quinolones, macrolides, and second-and third-generation cephalosporins were classified as broad-spectrum antibiotics. We evaluated trends in broad-spectrum antibiotic prescribing patterns and performed multivariable logistic regression to identify factors associated with broad-spectrum antibiotic use. RESULTS: Antibiotics were prescribed for 70% of pediatric UTI visits. Trimethoprim-sulfamethoxazole was the most commonly prescribed antibiotic (49% of visits). Broad-spectrum antibiotics were prescribed one third of the time. There was no increase in overall use of broadspectrum antibiotics (P ϭ .67); however, third-generation cephalosporin use doubled from 12% to 25% (P ϭ .02). Children younger than 2 years old (odds ratio: 6.4 [95% confidence interval: 2.2-18.7, compared with children 13-17 years old]), females (odds ratio: 3.6 [95% confidence interval: 1.6 -8.5]), and temperature Ն100.4°F (odds ratio: 2.9 [95% confidence interval: 1.0 -8.6]) were independent predictors of broadspectrum antibiotic prescribing. Race, physician specialty, region, and insurance status were not associated with antibiotic selection. CONCLUSIONS: Ambulatory care physicians commonly prescribe broad-spectrum antibiotics for the treatment of pediatric UTIs, especially for febrile infants in whom complicated infections are more likely. The doubling in use of third-generation cephalosporins suggests that opportunities exist to promote more judicious antibiotic prescribing because most pediatric UTIs are susceptible to narrower alternatives. To our knowledge, no previous study has examined ambulatory antibiotic prescribing patterns in the United States for children with UTIs. Studies in the adult literature have demonstrated an increase in the use of broad-spectrum antibiotics for UTIs, 4-6 raising concerns that unnecessar...

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Section: Summary Of Findingsmentioning

confidence: 99%

“…1,2 Frequently, a clinician must prescribe antibiotics empirically for UTIs because antibiotic administration is necessary before the return of urine culture results. Various factors are involved in antibiotic selection for outpatient treatment of UTIs, including patient age, allergies, cost, compliance and dosing frequency, and resistance patterns.…”

mentioning

confidence: 99%

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

Copp¹,

Shapiro

Hersh

2011

Pediatrics

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“…During recent years, the third cephalosporins and aminoglycosides are the preferred choice for initial empirical treatment of febrile children suspected with UTI (12,13). In this study, the susceptibility prevalence of E.coli as of most common uropathogens decreased significantly to the tested third cephalosporins and aminoglycosides; P 0.005, 0.000, 0.000, and 0.000 to CTX, CFX, AMK, and GEn respectively.…”

Section: Discussionmentioning

confidence: 52%

Increasing antibiotic resistance among uropathogens isolated during years 2006-2009: impact on the empirical management

et al. 2012

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Urinary tract infections (UTI) are one of the most common infections with an increasing resistance to antimicrobial agents. PURPOSE: Empirical initial antibiotic treatment of UTI must rely on susceptible data from local studies. MATERIALS AND METHODS: Retrospective analysis of isolated bacteria from children with UTIs was performed at the university hospital during years 2006-2009. The findings were compared with data collected in a similar study carried out in 2002- 2003. RESULTS: A total of 1439 uropathogens were isolated. Escherichia coli (E.coli) was the leading cause, followed by Enterobacter, and other gram negative bacilli. It was observed resistance of E.coli to ceftriaxone, cefexime, amikacin, gentamycin, and nalidixic acid; Enterobacter to cefexime; and the resistance of gram negative bacilli to gentamicin and cefexime increased significantly. The highest effective antibiotic was Imipenem, ciprofloxacin, and amikacin with 96.7%, 95% and 91% sensitivity rates , respectively, followed by ceftriaxone 77.2%, gentamicin 77%, nitrofurantoin 76.4%, nalidixic acid 74.3% and cefexime with 70%. CONCLUSION: The use of nitrofurantoin or nalidixic acid as initial empirical antibacterial therapy for cystitis seems appropriate. For cases of simple febrile UTI, the use of initial parenteral therapies with amikacin or ceftriaxone followed by an oral third generation cephalosporin also seemed appropriated, and in cases of severely ill patients or complicated UTI, imipenem as monotherapy or, a combination of Ceftriaxone with an aminoglycoside, are recommended

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“…24 In its practice parameter on febrile UTIs in infants 2 months to 2 years of age, the AAP recommends oral antibiotics for well-appearing children. 25 This recommendation is supported by a recent Cochrane review on the topic, 26 and at least 3 additional trials that have demonstrated that long IV courses do not yield better outcomes than shorter IV courses or oral only courses. [27][28][29] However, all of these trials exclude infants <1 month old, and there are no published recommendations for the <2-month-old age group.…”

Section: Utimentioning

confidence: 99%

Intravenous antibiotic durations for common bacterial infections in children: When is enough enough?

Schroeder

Ralston

2014

J. Hosp. Med.

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Durations of intravenous antibiotic therapy for bacterial infections in hospitalized children sometimes extend well beyond clinical recovery and are often the primary determinants of length of stay. These durations, however, are not always based on solid evidence. Moreover, fixed durations are invariant to important individual factors. We review guidelines and the available evidence for durations of intravenous antibiotic therapy for meningitis, bacteremia, urinary tract infection, and osteomyelitis, conditions where intravenous antibiotics often extend beyond resolution of clinical symptoms. We propose a framework for the duration of therapy that is intended to serve as a guide when standards of care are either nonexistent, dated, conflicting, or contrary to evidence from published studies. This framework incorporates patient‐centered factors such as severity of infection, response to therapy, ease of intravenous access, harms and costs of ongoing intravenous treatment, and family preferences. Journal of Hospital Medicine 2014;9:604–609. © 2014 Society of Hospital Medicine

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Antibiotics for acute pyelonephritis in children

Cited by 79 publications

References 59 publications

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

National Ambulatory Antibiotic Prescribing Patterns for Pediatric Urinary Tract Infection, 1998–2007

Increasing antibiotic resistance among uropathogens isolated during years 2006-2009: impact on the empirical management

Intravenous antibiotic durations for common bacterial infections in children: When is enough enough?

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