Best oral empirical treatment for pyelonephritis in children: Do we need to differentiate between age and gender?

Salomonsson, Petra; Linstow, Marie‐Louise von; Knudsen, Jenny Dahl; Heiberg, Ida Louise; Mola, Gylli; Wenger, Therese Ramstad; Cortes, Dina; Nygaard, Ulrikka

doi:10.3109/23744235.2016.1168937

Cited by 12 publications

(12 citation statements)

References 19 publications

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“…From the published results, it seems that the regimen for AUP in adults should be P-MEC ≥400 mg tid (adjusted for weight) for at least 14 days in adults with/without initially IV MEC. Both clinical 33 and retrospective data on resistance rates 41 support a recommendation of P-MEC in pediatric pyelonephritis, administered as 25–40 mg/kg/day bid / tid for 10 days. 33 …”

Section: Discussionmentioning

confidence: 82%

Mecillinam for the treatment of acute pyelonephritis and bacteremia caused by Enterobacteriaceae: a literature review

Jansåker

Frimodt‐Møller

Benfield

et al. 2018

IDR

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PurposeThe pharmacokinetic properties of mecillinam (MEC) for urinary tract infections are excellent, and the resistance rate in Enterobacteriaceae is low compared to other recommended antibiotics. The oral prodrug pivmecillinam (P-MEC) has been used successfully as first choice for cystitis in the Nordic countries for many years. Norwegian and Danish guidelines also recommend P-MEC for acute uncomplicated pyelonephritis (AUP) and intravenous (IV) MEC for suspected urosepsis (only in Denmark). Here, we wish to present an updated investigation on the clinical data behind these recommendations together with sparse but more current clinical data.MethodsProspective clinical trials evaluating MEC as monotherapy or in polytherapy with one other beta-lactam (mostly ampicillin [AMP]) for pyelonephritis or bacteremia were reviewed. Outcomes of primary interest were clinical and bacteriological success and relapse, respectively. Search databases used were PubMed, Cochrane Library, and Embase.ResultsTwelve clinical studies (1979–2015) were included in this integrated literature review. Clinical success was seen in 38/51 (75%) patients treated with MEC as monotherapy and in 152/164 (93%) patients treated with MEC and one other beta-lactam. Bacteriological success was seen in 35/47 (74%) and 117/167 (70%) patients treated with MEC alone and with one other beta-lactam, respectively. In complicated infections, bacteriological success was much lower. Clinical relapse rate was not well described. Several uropathogenic bacteremia cases were treated successfully with MEC alone (ie, 10/15 [67%] and 13/15 [87%] for clinical and bacteriological success, respectively) or with one other beta-lactam (ie, 57/65 [88%] and 53/63 [84%] for clinical and bacteriological success, respectively). However, data on bacteremia are very sparse. Adverse reactions were few and mild (73/406 [18%]) and primarily seen when AMP was co-administered (69/73 [95%]). No serious adverse reactions were reported.ConclusionIV MEC or oral P-MEC for 14 days may be suitable for the treatment of AUP and pediatric pyelonephritis. Randomized controlled trials using a single standardized dose of P-MEC compared to other current recommendations are warranted. Similarly, more evidence is required before MEC should be recommended for bacteremia or sepsis due to Enterobacteriaceae.

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Section: Discussionmentioning

confidence: 82%

Mecillinam for the treatment of acute pyelonephritis and bacteremia caused by Enterobacteriaceae: a literature review

Jansåker

Frimodt‐Møller

Benfield

et al. 2018

IDR

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“…Pivmecillinam is recommended for empiric therapy of UTI in adults and children in many places in Northern Europe [51,53]. In vitro studies suggest some effectiveness against ESBL-producing E. coli, particularly in combination with another agent such as amoxicillinclavulanate [54].…”

Section: Mild or Uncomplicated Mdr Utimentioning

confidence: 99%

Multidrug-resistant organisms in urinary tract infections in children

et al. 2019

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The global spread of multidrug-resistant organisms has led to an increase in urinary tract infections (UTIs) in children that are difficult to treat. This review explores the current literature regarding multidrug-resistant UTIs in childhood and proposes an approach to management. Multidrug-resistant organisms include a wide range of potential urinary tract pathogens and, while most literature on drug resistance in UTIs during childhood has focused on extended-spectrum beta-lactamase producing organisms, in this review, we have included a discussion of multidrug resistance including and beyond beta-lactamase production. We provide definitions for multidrug-resistant organisms in line with current consensus guidelines and summarise clinically relevant mechanisms of resistance. Additionally, in this review, we outline the global epidemiology of multidrug-resistant UTIs in children, summarising published prevalence rates, which range from 5 to 90% in different settings. Finally, we also critically review the evidence on risk factors for colonisation and infection of the urinary tract with multidrug-resistant organisms, including prior antibiotic use, hospitalisation and underlying urological malformations. We also highlight multidrug-resistant UTI occurring in children without any identifiable risk factors, reflecting an increasing prevalence of colonisation with these organisms in the general community. Taken as a whole, this emphasises a need for careful and evidence-based use of antibiotics when treating UTIs in children and, to aide clinicians, we have outlined here potential management strategies for when infection with a multidrug-resistant organism is suspected or confirmed.

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“…A total of 378 urine cultures from children with pyelonephritis were assessed in a study aimed at the determination of the optimal oral treatment options in children with UTIs. 24 Importantly, the most common organism in children in the 0 to 16 age group was E.coli (85%). Among the antibiotics used in the study, the lowest resistance rates in 378 isolates were observed against pivmecillinam and amoxicillin-clavulanate (6.9 and 7.2%, respectively).…”

Section: Discussionmentioning

confidence: 99%

Mecillinam: Old Molecule, New Option

Bilman¹,

Yetik²

2018

J Pediatr Infect Dis

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Background Mecillinam is a β-lactam antibiotic that is increasingly being used for the treatment of uncomplicated urinary tract infections. Nevertheless, the international guidelines still recommend nitrofurantoin, fosfomycin trometamol, and pivmecillinam as first-line agents in the treatment of such infections. Aim The objective of this study was to determine the in vitro efficacy of mecillinam against Escherichia coli and Klebsiella pneumoniae strains isolated from children with urinary tract infections. Materials Methods We investigated E. coli and K. pneumoniae isolates, obtained within the period from January 2016 to October 2017, from urine samples of patients aged 0 to 16 years. Antibiotics susceptibility testing was conducted through the disk diffusion method based on the guidelines provided by EUCAST (European Committee on Antimicrobial Susceptibility Testing). Extended-spectrum β-lactamase (ESBL)-positivity was detected by the double-disk synergy test. Isolates with mecillinam inhibition-zone diameter breakpoints lower than < 15 mm were considered to be resistant according to EUCAST criteria. Results A total of 450 isolates were assessed in the study, 135 of which were ESBL-producing E.coli, 230 were non-ESBL-producing E. coli, 35 were ESBL-producing K. pneumoniae, and 50 were non-ESBL-producing K. pneumoniae isolates. Mecillinam susceptibility was observed in most of the non-ESBL-producing and ESBL-producing E. coli isolates (230/230, 100% and 115/135, 85.1%, respectively). The rates of susceptibility of the non-ESBL-producing and ESBL-producing K. pneumoniae isolates were 37/50 (74%) and 24/35 (68.6%), respectively. Conclusion The in vitro susceptibility results obtained support the usage of mecillinam as a first-line agent. The high susceptibility of non-ESBL-producing E. coli and K. pneumoniae isolates established in vitro brings the hope that this antibiotic could soon be used in clinical practice in Turkey.

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Best oral empirical treatment for pyelonephritis in children: Do we need to differentiate between age and gender?

Abstract: This study recommends piv-mecillinam or amoxicillin-clavulanate as empirical treatment of first time pyelonephritis in Danish children from 6 months of age. Age and gender of patients should be taken into consideration when initiating empirical treatment.

Cited by 12 publications

References 19 publications

Mecillinam for the treatment of acute pyelonephritis and bacteremia caused by Enterobacteriaceae: a literature review

Mecillinam for the treatment of acute pyelonephritis and bacteremia caused by Enterobacteriaceae: a literature review

Multidrug-resistant organisms in urinary tract infections in children

Mecillinam: Old Molecule, New Option

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