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Cefixime in Paediatric Urinary Tract Infection Management

Cefine (Cefixime)

Recommendations by the Pediatric Infectious Diseases Group of the French Pediatrics Society and the French-Language Infectious Diseases Society for the management of urinary tract infections in children

The Pediatric Infectious Diseases Group of the French Pediatrics Society and the French-Language Infectious Diseases Society recommend the following for the management of urinary tract infections in children:

  • For screening of urinary tract infections (UTI) in febrile infants and children, urine dipsticks have to be used more frequently
  • Other methods of sampling urine culture should be employed
  • for confirmation of UTI than the urine bag such as sampling jet, urethral catheterization, or pubic puncture
  • The use of carbapenems as the first-line treatment makes the patients vulnerable to the risk of untreatable infections
  • In case of febrile UTI, the expert group recommended:
    • Approbation of the initial treatment with aminoglycosides (particularly amikacin) for majority of ESBL strains of patients seen in the pediatric emergency department and/or hospital
    • Owing to the low percentage of ESBL-producing enterobacteria strains, ceftriaxone (IV or IM) is favored as an appropriate treatment for patients seen in the emergency department or outpatient clinic
    • Oral cefixime use can be advocated in non-severe cases and low-risk patients defined as age>3 months, general condition preserved, duration of fever<4 days, no associated comorbidity, and no history of UTI, uropathy, or prior antibiotic therapy in the last 3 months
    • In-vitro susceptibility testing is used to guide the oral relay for parenteral treatment to reduce the use of oral cephalosporins in order to limit the selection of resistant bacterial strains
  • The recommended duration of treatment is usually 10 days. Except for some special circumstances, retrograde cystography or antibiotic prophylaxis is not recommended after a first febrile UTI. In case of cystitis, the panel recommends systematic urinalysis and initial prescription before the procurement of the results of the urine culture for susceptibility to one of the three following oral antibiotics: amoxicillin- clavulanate, cotrimoxazole, cefixime. The total duration of antibiotic treatment based on clinical progression and antibiotic susceptibility is 5 days.

"Oral cefixime use can be advocated in non-severe cases and low-risk patients"

Source:

Cohen R, Raymond J, Faye A, Gillet Y, Grimprel E. Management of urinary tract infections in children. Recommendations of the Pediatric Infectious Diseases Group of the French Pediatrics Society and the French- Language Infectious Diseases Society.  Arch Pediatr.  2015 Jun; 22(6):665-71