Which medications in the drug class Antibiotics are used in the treatment of Pediatric Urinary Tract Infection?

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

Antibiotics

Antibiotics are used to treat bacterial infections of the urinary tract. Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting.

Ceftriaxone (Rocephin)

This third-generation cephalosporin is used for initial parenteral therapy for complicated pyelonephritis in pediatric patients beyond the neonatal period. It is indicated for urinary tract infections caused by E coli, Proteus mirabilis, Morganella morganii, P vulgaris, or K pneumoniae.

Cefotaxime (Claforan)

Cefotaxime is a third-generation cephalosporin that is used as initial parenteral therapy for pediatric patients with acute complicated pyelonephritis. It may be used in neonates or jaundiced patients. Dosing every 6-8 hours is required. In infants, a 2- to 8-week regimen also includes ampicillin.

Ampicillin (Marcillin, Omnipen, Polycillin)

Ampicillin is a parenteral agent used for initial treatment of patients with acute pyelonephritis who have gram-positive cocci in urinary sediment or in whom no organisms are observed in the urine. It is indicated for UTIs caused by E coli and P mirabilis.

Amoxicillin and clavulanate (Augmentin, Amoclan)

This is an oral therapy for infection with susceptible organisms. Amoxicillin inhibits bacterial cell-wall synthesis by binding to penicillin-binding proteins. The addition of clavulanate inhibits beta-lactamase ̶ producing bacteria.

This is a good alternative antibiotic for patients who are allergic to or intolerant of the macrolide class. It is usually well tolerated and is effective against most infectious agents, although it is not effective against Mycoplasma and Legionella species. It has good tissue penetration but does not enter the cerebrospinal fluid (CSF).

For patients over age 3 months, base dosing protocol on amoxicillin content. Because of different amoxicillin/clavulanic acid ratios in the 250-mg tablet (250/125) versus the 250-mg chewable tablet (250/62.5), do not use the 250-mg tablet until the child weighs over 40 kg. The amoxicillin-clavulanate combination is also available as an oral suspension for children. The half-life of the oral form is 1-1.3 hours.

Gentamicin

This aminoglycoside is used for initial parenteral therapy in patients with bacterial pyelonephritis who are allergic to cephalosporins. For complicated UTI, it is sometimes used in combination with a cephalosporin.

Sulfamethoxazole and trimethoprim (Bactrim, Cotrim, Septra)

This is an oral treatment for bacterial UTI and for prevention of reinfection. It is available as an oral tablet or a suspension.

Cephalexin (Keflex)

Cephalexin is a first-generation cephalosporin. This is an oral treatment for bacterial UTI and for prevention of infection in infants younger than 6-8 weeks.

Cefixime (Suprax)

Cefixime is a third-generation cephalosporin used for oral treatment of acute bacterial UTI. By binding to 1 or more penicillin-binding proteins, it arrests bacterial cell-wall synthesis and inhibits bacterial growth.

Ceftazidime/avibactam (Avycaz)

Indicated for complicated urinary tract infections (cUTIs) including pyelonephritis in adult and pediatric patients aged 3 months or older caused by the following susceptible Gram-negative microorganisms: Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Citrobacter freundii complex, Proteus mirabilis, and Pseudomonas aeruginosa.

Cefpodoxime

Cefpodoxime is a third-generation cephalosporin used for oral treatment of acute bacterial UTI. It is indicated for the management of infections caused by susceptible mixed aerobic-anaerobic microorganisms.

Nitrofurantoin (Furadantin, Macrobid, Macrodantin)

This is an oral treatment for bacterial infections of the lower urinary tract (cystitis) and for the prevention of reinfection. Nitrofurantoin is a synthetic nitrofuran that interferes with bacterial carbohydrate metabolism by inhibiting acetylcoenzyme A. It is bacteriostatic at low concentrations (5-10 mcg/mL) and is bactericidal at higher concentrations.

Trimethoprim (Primsol)

Trimethoprim is an oral antibiotic used for the prevention of urinary tract infection. It is a dihydrofolate reductase inhibitor that prevents the production of tetrahydrofolic acid in bacteria. It is active in vitro against a broad range of gram-positive and gram-negative bacteria, including uropathogens (eg, Enterobacteriaceae and Staphylococcus saprophyticus).

Resistance is usually mediated by decreased cell permeability or by alterations in the structure or amount of dihydrofolate reductase. Trimethoprim demonstrates synergy with sulfonamides, potentiating inhibition of bacterial tetrahydrofolate production.

Ciprofloxacin (Cipro, Cipro XR)

This agent is a fluoroquinolone that inhibits bacterial DNA synthesis and, consequently, growth by inhibiting DNA gyrase and topoisomerases, enzymes that are required for the replication, transcription, and translation of genetic material. Quinolones have broad activity against gram-positive and gram-negative aerobic organisms. Ciprofloxacin has no activity against anaerobes. Continue treatment for at least 2 days (7-14 days typical) after signs and symptoms have disappeared.

This agent is not a drug of first choice in pediatric patients, because of an increased incidence of adverse events, including arthropathy, compared with controls. No data exist for dose adjustments for pediatric patients with renal impairment.

Tobramycin

Tobramycin may be an option for the empiric parenteral treatment of UTI. It is used in skin, bone, and skin-structure infections caused by Staphylococcus aureus, Pseudomonas aeruginosa, and E coli, as well as by Klebsiella, Proteus, and Enterobacter species.

This agent is indicated in the treatment of staphylococcal infections when penicillin or potentially less toxic drugs are contraindicated and when bacterial susceptibility and clinical judgment justify its use. Dosing regimens are numerous and are adjusted on the basis of creatinine clearance (CrCl) and changes in the volume of distribution.


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