Aztreonam in the treatment of severe urinary tract infections in pediatric patients

Abstract

MATERIALS AND METHODSPatients. The study population consisted of 30 patients, 16 males and 14 females, with a mean age of 4.2 years (range, 0.03 to 15.4 years). Underlying urological abnormalities (12 cases of hydronephrosis, 9 of grade III to IV vesico-ureteral reflux, 3 of uretero-pelvic junction obstruction, 2 of spastic neurogenic bladder, and 5 cases of other multiple abnormalities of the urinary tract) were present in 21 patients of whom 10 had surgical treatment for their urological abnormalities in the previous 2 weeks. One patient had renal calculosis. According to the normal values for age given by Goldsmith (7), 13 patients had renal failure, mild in 6, moderate in 5, and severe in 2 (creatinine clearance, 50 to 80, 30 to 50, and <30 ml/min per 1.73 m2, respectively). In patients <13 years old, glomerular filtration rate was estimated from plasma creatinine concentration and body length by using two different formulas for patients who were <1 year and >1 year old (24,25). Seven patients had been previously treated for the same infection in another hospital with appropriate doses (one case each) of co-trimoxazole, ampicillin, cefotaxime, piperacillin, gentamicin, amikacin, and netilmicin. These antibiotics were reported to be initially active in vitro against the infecting organisms. We discontinued them after at least 6 days because of microbiological failure (bacteriuria > 105 CFU/ml and the development in 6 of 7 cases of in vitro resistance to the drug as determined by Kirby-Bauer criteria). Before aztreonam treatment, seven other patients received co-trimoxazole and six received ampicillin as prophylactic antibiotics; in these cases, also, the pathogens were 310

Clinical Pharmacokinetics of Aztreonam

“…7 (Swabb et al 1981) to 2.0 hours (Scully et al 1983). In children, total plasma clearance is very dependent on age or gestational age (Likitnukul et al 1987;Rusconi et al 1986;Stutman et al 1984). In premature infants aztreonam clearance is less than 0.06 L/h/kg, and increases with age to about 0.12 L/h/kg.…”

Aztreonam

“…In another series of 30 infants and children (21 of which were complicated by underlying urologic abnormalities, including hydronephrosis, vesicoureteral reflux, ureteropelvic junction obstruction and neurogenic bladder), permanent clinical and microbiologic cures were achieved in 73% of patients. 43 Based on the above studies, aztreonam has proven to be effective as a single agent in children and adults for the treatment of complicated or uncomplicated urinary tract infections caused by susceptible gram-negative organisms. Aztreonam has also been effective in some patients with prostatitis31 although more data are required to determine its usefulness in this clinical situation.…”