What is the recommended treatment of cystitis and pediatric urinary tract infection (UTI)?

Updated: Mar 19, 2019
  • Author: Donna J Fisher, MD; Chief Editor: Russell W Steele, MD  more...
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Answer

Children with cystitis usually do not require special medical care other than appropriate antibiotic therapy and symptomatic treatment if voiding symptoms are marked. Antibiotic therapy is started on the basis of the practitioner's appraisal of the patient's clinical history and urinalysis results before the diagnosis is documented.

A 4-day course of an oral antibiotic agent is recommended for the treatment of cystitis (see Table 4). A systematic review of treatments for cystitis in children showed no difference in efficacy with 7-14 days of therapy compared with 2-4 days. [26] Single-dose or single-day therapy is not recommended in children with cystitis. If the clinical response is not satisfactory after 2-3 days, alter therapy on the basis of antibiotic susceptibility.

Symptomatic relief for dysuria is accomplished by increasing fluid intake to enhance urine dilution and output and with the use of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs). If voiding symptoms are severe and persistent, add phenazopyridine hydrochloride (Pyridium). Do not administer phenazopyridine for longer than 48 hours, because of the risk of methemoglobinemia, hemolytic anemia, and other adverse reactions. Sitting in a tub of warm water for 20-30 minutes 3-4 times daily also often affords symptomatic relief.

Table 4. Antibiotic Agents for the Oral Treatment of Urinary Tract Infection (Open Table in a new window)

Protocol

Daily Dosage

Sulfamethoxazole and trimethoprim (SMZ-TMP)

30-60 mg/kg SMZ, 6-12 mg/kg TMP divided q12h

Amoxicillin and clavulanic acid

20-40 mg/kg divided q8h

Cephalexin

50-100 mg/kg divided q6h

Cefixime

8 mg/kg q24h

Cefpodoxime

10 mg/kg divided q12h

Nitrofurantoin*

5-7 mg/kg divided q6h

*Nitrofurantoin may be used to treat cystitis. It is not suitable for the treatment of pyelonephritis, because of its limited tissue penetration.


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