Treatment of Urinary Tract Infections Among Febrile Young Children With Daily Intravenous Antibiotic Therapy at a Day Treatment Center

Abstract

ABSTRACT. Objective. Urinary tract infections (UTIs) are common among infants and toddlers. Children can be treated effectively with short courses (2-4 days) of intravenous (IV) therapy followed by oral therapy. If IV therapy is chosen, use of once-daily dosing may allow outpatient management instead of hospital admission. However, no description of ambulatory treatment with IV antibiotics of UTI among febrile children has been reported to date. We aimed to describe the feasibility and complications of outpatient management with IV antibiotics of UTI among febrile children, at the day treatment center (DTC) of a tertiary-care pediatric hospital.Methods. Between April 1, 2002, and March 31, 2003, a prospective cohort of patients 3 months to 5 years of age who were examined in the emergency department (ED) and diagnosed as having presumed febrile UTI were treated according to a clinical protocol. Patients were treated at the DTC unless they met exclusion criteria, in which case they were hospitalized. The DTC was open 7 days per week, including holidays, from 8:30 AM to 4:30 PM. At the DTC, patients were initially treated with a daily dose of IV gentamicin, until the child had been afebrile for at least 24 hours, and with oral amoxicillin, until preliminary urine culture results were available. Children allergic to penicillin received gentamicin only. IV antibiotics were administered through peripheral IV access; the IV catheter's patency was maintained with injection of 50 U of heparin once daily throughout the treatment period. Parental satisfaction with the DTC experience was assessed with an anonymous, self-administered questionnaire.Results. Two hundred ninety-one episodes of presumed febrile UTI were diagnosed in the ED, of which 212 (72.9%) were sent to the DTC. There were 71 hospital admissions (24.4%); in 9 of these instances, the child was admitted because parents refused or were unable to comply with DTC treatment. Adherence to the treatment protocol in the ED was excellent; in 92.1% of presumed febrile UTI episodes (268 of 291 episodes), the patient was referred to the appropriate setting for treatment. In 8 instances, patients who met an exclusion criterion were sent to the DTC. They should have been hospitalized, according to the protocol. At the DTC, a final diagnosis of UTI was made in 178 of the 212 episodes (84%). Patients treated at the DTC, with a final diagnosis of UTI, had a median age of 12.0 months (range: 3-68 months), and their mean initial temperature was 39.2°C (SD: 1.1°C). Patients were afebrile by 24 hours in 52% of UTI episodes and by 48 hours in 82%. Minor problems with IV access occurred in 9.0% of cases. The duration of IV antibiotic therapy at the DTC was 1.9 days (SD: 0.9 day). The mean number of visits to the DTC, including appointments for renal ultrasound and voiding cystourethrography evaluations, was 3.5 (SD: 0.9). Parents were present at all scheduled visits in 98.9% of cases. Four patients needed to be hospitalized from the DTC, but in only 1 case was hospital admission r...

Factors Associated With Bacteremia in Young Infants With Urinary Tract Infection

“…One study reports that creatinine values did not differ in bacteremic versus nonbacteremic children with UTI aged 7 days to 9.5 years. 22 The association between increased blood creatinine and bacteremia could be underreported, as many published studies include both young infants and older children. [11][12][13][14][15][16]23 Creatinine levels undergo physiologic changes during the first weeks of life.…”

Manejo de la infección del tracto urinario en lactantes febriles: Experiencia de tratamiento antimicrobiano intravenoso ambulatorio

“…El uso de amikacina y ceftriaxona, en dosis única en niños, es seguro, con adecuado espectro de acción para los microorganismos causantes de ITU en el grupo descrito, logra buenas concentraciones en el parénquima renal, encierra escasas reacciones adversas [14][15][16][17][18] y ambos están disponibles en nuestro medio. El tiempo de duración del tratamiento iv (2,8 días) fue levemente superior a lo descrito en otras experiencias 13 , pero estuvo determinado, en parte, por el tiempo necesario para obtener el aislamiento de microorganismos en cultivos de orina y su susceptibilidad in vitro. La distribución por género, en nuestro medio, fue similar a la descrita en la bibliografía, al igual que el agente etiológico más frecuente (E. coli).…”

“…Esta modalidad ha resultado eficaz y segura, logrando a su vez reducir los costos de tratamiento. Existen algunas publicaciones que proponen esta forma de tratamiento como una buena alternativa para lactantes con ITU y 13 . Actualmente, se dispone de antimicrobianos (ceftriaxona y amikacina) que pueden ser administrados una vez al día con demostrada eficacia y seguridad en pacientes pediátricos, sin reportarse efectos adversos de importancia ni complicaciones de la vía venosa [14][15][16][17] .…”

Critical Analysis of a Series of Early Inguinal Ureterostomies: Are They Useful and How Well Are They Tolerated?

“…Even though ureterostomy induces a need for further surgery, it avoids part of the morbidity associated with pyelonephritis (antibiotics side effects, intravenous injection, and hospitalization) and selection of resistant bacteria due to repeated antibiotic pressure [29][30][31][32] .…”