Antibiotics for acute pyelonephritis in children

Strohmeier, Yvonne; Hodson, Elisabeth M; Willis, Narelle S; Webster, Angela C; Craig, Jonathan C.

doi:10.1002/14651858.cd003772.pub4

Cited by 77 publications

(82 citation statements)

References 77 publications

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“…There is a paucity of studies of antibiotic courses shorter than 14 days in pediatric pyelonephritis (27). However, 7 days of antibiotics is probably adequate for most cases with a 10 day course reserved for children with bacteremia or a slow response to antibiotics.…”

Section: Further Management Once Urine Culture Results Are Availablementioning

confidence: 99%

“…Some experts believe that beta lactams are inferior to other classes of antibiotics for UTI (28) but the evidence is not convincing for children (27). Enterococci are unusual causes of UTI in the absence of instrumentation, a neurogenic bladder, or antibiotic prophylaxis and are not as virulent as are gram negatives so it is no longer common practice to add empiric ampicillin unless recent UTIs were attributed to ampicillin-susceptible enterococci.…”

Section: Initial Management Of Presumptive Utismentioning

confidence: 99%

See 1 more Smart Citation

Management of urinary tract infections in children in an era of increasing antimicrobial resistance

Robinson

Saux

2016

Expert Review of Anti-infective Therapy

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The article reviews indications for and interpretation of urinalysis and urine culture results for diagnosis of UTI, choice of antibiotics for empiric and definitive UTI therapy, the rationale behind and indications for radiographic investigations, and prevention of UTIs including the complex decision as to whether antibiotic prophylaxis will benefit a child. Expert commentary: Over-diagnosis of UTI is a prevalent problem due to the lack of specificity of both urinalysis and urine culture. The most major recent advance in the field has been the recognition that antibiotic prophylaxis for UTI is rarely indicated as in most situations, the number needed to treat to prevent one UTI is too high to justify the risk of adverse events and development of antimicrobial resistance.

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Section: Further Management Once Urine Culture Results Are Availablementioning

confidence: 99%

Section: Initial Management Of Presumptive Utismentioning

confidence: 99%

Management of urinary tract infections in children in an era of increasing antimicrobial resistance

Robinson

Saux

2016

Expert Review of Anti-infective Therapy

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“…Only a small fraction, less than 9%, of antibiotic administrations were oral; more than 90% of antibiotic treatments were administered parenterally. As the children included in this study had been hospitalized for treatment of infectious diseases, substantial antibiotic usage was expected; however, experts recommend switching from parenteral to oral medication once the child is stable, or even initiating the treatment with oral antibiotics, especially in children with UTI and pneumonia (9)(10)(11). Overuse of injections leads to numerous adverse effects, including needle stick injuries and transmission of blood-borne infections (12-14).…”

Section: Discussionmentioning

confidence: 99%

Pattern of Antibiotic Usage in Children Hospitalized for Common Infectious Diseases

Shiva

Ghanaie

Shirvani

et al. 2017

Arch Pediatr Infect Dis

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Background: Antibiotic misuse is a major cause of antimicrobial resistance. Objectives: The present study aimed at determining the pattern of antibiotic usage in previously healthy children hospitalized for common infectious diseases in a tertiary care children's hospital. Methods: This study was the second part of a previous study in which inpatient charts of children hospitalized from October 2013 to September 2014 were reviewed to determine the rationality of drug use. Data from the first study were analyzed to define the antibiotic usage pattern in urinary tract infection, acute meningitis, community acquired pneumonia, fever without a localized source and acute gastro-enteritis. The data were checked independently by two pediatric infectious disease specialists to assess the appropriateness of prescribed antibiotics and in case of disagreement, rechecked by a third member. Results: Hospital charts of 140 children were reviewed; 47 had been treated for urinary tract infection, 31 for pneumonia, 25 for acute meningitis, 24 for acute gastroenteritis and 13 for fever without a localized source. One-hundred and fourteen children (81.42%) received 208 prescriptions for antibiotics (1.82 antibiotics/patient). Nineteen different antibacterial drugs and 2 antivirals (acyclovir and oseltamivir) were prescribed. Most frequently prescribed antibiotic was ceftriaxone. More than 25% of prescriptions for antibiotics were needless. In 91.6% of the prescriptions the medications had been prescribed by generic names. Dosing errors were observed in less than 7% and patients received the medication for prolonged duration, 25.6% of times. Conclusions: Nonuniformity of antibiotic usage, a high rate of needless antibiotic prescriptions, and prolonged administration found in this study call for stringent antibiotic stewardship.

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“…Nevertheless, short courses of intravenous antibiotics (up to 4 days) followed by oral therapy are as effective as longer courses of intravenous treatment (7-14 days) [46][47][48][49][50]. Recent evidence [6,7,[51][52][53], moreover, suggests that oral antibiotic treatment alone is as effective as initial parenteral treatment followed by oral antibiotics.…”

Section: Treatment and Hospitalizationmentioning

confidence: 99%

“…A Cochrane review update on antibiotic treatment for AP performed in 2014 [51] found four studies [6,7,52,53] involving 1131 children comparing oral antibiotics for 10 to 14 days with intravenous followed by oral antibiotics. Time to resolution of fever and the number of children with persistent AP at 72 h after the start of therapy did not differ significantly between groups.…”

Section: Treatment and Hospitalizationmentioning

confidence: 99%

Acute pyelonephritis in children

et al. 2015

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Acute pyelonephritis is one of the most serious bacterial illnesses during childhood. Escherichia coli is responsible in most cases, however other organisms including Klebsiella, Enterococcus, Enterobacter, Proteus, and Pseudomonas species are being more frequently isolated. In infants, who are at major risk of complications such as sepsis and meningitis, symptoms are ambiguous and fever is not always useful in identifying those at high risk. A diagnosis of acute pyelonephritis is initially made on the basis of urinalysis; dipstick tests for nitrites and/or leukocyte esterase are the most accurate indicators of infection. Collecting a viable urine sample for urine culture using clean voided methods is feasible, even in young children. No gold standard antibiotic treatment exists. In children appearing well, oral therapy and outpatient care is possible. New guidelines suggest less aggressive imaging strategies after a first infection, reducing radiation exposure and costs. The efficacy of antibiotic prophylaxis in preventing recurrence is still a matter of debate and the risk of antibiotic resistance is a warning against its widespread use. Well-performed randomized controlled trials are required in order to better define both the imaging strategies and medical options aimed at preserving long-term renal function.

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Antibiotics for acute pyelonephritis in children

Cited by 77 publications

References 77 publications

Management of urinary tract infections in children in an era of increasing antimicrobial resistance

Management of urinary tract infections in children in an era of increasing antimicrobial resistance

Pattern of Antibiotic Usage in Children Hospitalized for Common Infectious Diseases

Acute pyelonephritis in children

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