Antimicrobial Pharmacotherapy Management of Urinary Tract Infections in Pediatric Patients

Abstract

To discuss the risk factors, microbial resistance rates, and pharmacotherapy, including antimicrobial choices and medication dosage regimens, for urinary tract infections (UTIs) in pediatric patients. Data Sources: A MEDLINE literature search (1985 to December 2017) was performed using the following keywords and associated medical subject headings: urinary tract infection, antimicrobial, treatment, and children. Study Selection and Data Extraction: Search was conducted to identify clinical trials, systematic reviews, and guidelines. Search was filtered to include studies with age range between birth and 18 years and published in English. Additional references were identified from selected review articles. Data Synthesis: In total, 27 studies investigating microbial resistance, 31 studies assessing antimicrobial efficacy, 34 studies describing prophylaxis, and 6 systematic reviews were included. The resistance patterns differed across age groups and affected the choice of empirical therapy. If pyelonephritis is suspected, empiric antimicrobials should have high urinary and sufficient parenchymal concentrations. Nitrofurantoin has low microbial resistance rates and can generally be used empirically for treating uncomplicated cystitis in children >1 month of age. Trimethoprim-sulfamethoxazole resistance has increased and should be avoided unless local susceptibility data are available. Certain patients with recurrent UTIs or renal abnormalities may require antimicrobial prophylaxis, which may be associated with adverse effects, such as intolerability or an increased risk of microbial resistance. Conclusion: The resistance pattern of uropathogens should be considered prior to initiating therapy. Controlled trials with large samples are needed to compare the treatment duration of various antimicrobial regimens and the specific role of prophylactic antimicrobials.

Bacterial Profile and Antibiotic Resistance Pattern among Children with Urinary Tract Infections in Dr. Soetomo Hospital, Surabaya, Indonesia

“…30 However, this still requires further research in the form of randomized controlled trials (RCT). 31 This study showed that the five most common gramnegative bacteria were sensitive to carbapenems (imipenem, meropenem), amikacin, and piperacillin-tazobactam, similar to Rahmadi in his research on UTI patients at the Department of Internal Medicine Dr. Soetomo Hospital. 32 In Taiwan, Wu et al reported that E. coli was resistant to ampicillin, piperacillin, trimethoprim-sulfamethoxazole, and sensitive to amikacin, imipenem, ceftazidime, ceftriaxone, and cefuroxime, gentamicin.…”

“…14 The increasing resistance of trimethoprim-sulfamethoxazole in various regions has resulted in this antibiotic being no longer recommended as empiric therapy unless it is proven to be sensitive according to local antibiogram data. 31 Meanwhile, cefoperazonesulbactam showed a sensitivity of more than 90% in ESBL-producing Enterobacteriaceae. 34 Tigecycline is well tolerated in cases of serious Extensively Drug-Resistant (XDR) gramnegative bacterial infections 35 , but should not be used as monotherapy in pediatric UTIs because of its limited excretion and some side effects, enamel hypoplasia.…”

Computer-Aided Design of Cefuroxime Axetil/Cyclodextrin System with Enhanced Solubility and Antimicrobial Activity

“…Cefuroxime exhibits a broad spectrum of activity against Gram-negative and Gram-positive bacteria [1]. The main indications include respiratory tract infections, middle ear infections, sinus infections caused by non-β-lactamase-producing strains, and treatment of urinary tract infections also of pediatric patients [2,3]. Esterification of cefuroxime into the prodrug form facilitated its permeation, resulting in increased bioavailability, and enabled the development of oral formulations [4].…”

Antibiotic Stewardship and Treatment of Uncomplicated Urinary Tract Infection (UTI) in Children and Adolescents in the Emergency Department of a Community Hospital

“…Females and uncircumcised males 5,20 had a higher rate of UTIs. 21 About a third of all women had a contaminated UC, but only 6% had an antibiotic change and none had antibiotic discontinuation. Patients with a contaminated UC did not have a repeat culture performed to confirm a UTI diagnosis.…”