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J Microbiol Immunol Infect. 2003 Mar;36(1):56-60.
Is combination antimicrobial therapy required for urinary tract infection in children?
Lu KC, Chen PY, Huang FL, Yu HW, Kao CH, Fu LS, Chi CS, Lau YJ, Lin JF.
Department of Pediatrics, Taichung Veterans General Hospital, Taiwan, ROC.
This retrospective study examined the characteristics of 338 pediatric patients presenting with a first episode of symptomatic urinary tract infection at Taichung Veterans General Hospital from November 1996 to December 2001. Escherichia coli was the most common pathogen (72.5%), followed by Proteus mirabilis (8.3%), Enterococcus (5.6%), and Klebsiella pneumoniae (4.7%). They were more susceptible to first-generation cephalosporin in comparison with other first-line antimicrobial agents such as trimethoprim/sulfamethoxazole, ampicillin, and gentamicin. Two hundred and eighty-seven (84.9%) of the 338 patients were divided into 3 groups according to the type of antibiotic treatment received, and the susceptibility rate and the averaged day of defervescence after effective antibiotic therapy were compared among the groups. Group 1 consisted of those patients treated with cefazolin or cephalexin alone (95%, 2.1 days); Group 2, cefazolin plus gentamicin (88.9%, 2.8 days); and Group 3, ampicillin plus gentamicin (76.1%, 2.3 days). A total of 38 (13.2%) cases from the 3 antibiotic groups did not respond to empiric antibiotics. For non-susceptible infections, when the antibiotic regimen was switched from cefazolin plus gentamicin to ampicillin alone, only 4 (20%) strains became susceptible, compared with 10 strains (62.5%) becoming susceptible after switching from ampicillin plus gentamicin to cefazolin alone (p < 0.01). The results indicated that first-generation cephalosporin alone is an appropriate treatment for pediatric cases of community-acquired urinary tract infection and suggest that antimicrobial combinations should be reserved for serious or critical cases.
online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12741735&dopt=Abstract
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