The addition of ceftriaxone to oral therapy does not improve outcome in febrile children with urinary tract infections.
OBJECTIVE
To determine whether the addition of a single dose of ceftriaxone sodium to a 10-day course of trimethoprim and sulfamethoxazole hastens urine sterilization or resolution of clinical symptoms in febrile children with urinary tract infections.


METHODS
Prospective, single-blind, randomized study.


METHODS
Tertiary care children's hospital emergency department.


METHODS
Febrile children aged 6 months to 12 years with a presumptive urinary tract infection based on history, physical examination, and urinalysis findings.


METHODS
A history was taken, a physical examination and urinalysis and culture were performed, and a white blood cell count and erythrocyte sedimentation rate were obtained. Children were randomized to receive an intramuscular dose of ceftriaxone then 10 days of trimethoprim-sulfamethoxazole (IM + PO group) or oral trimethoprim-sulfamethoxazole alone (PO group). After receiving study medication, patients were discharged from the hospital to return in 48 hours for a follow-up evaluation and urine culture. Treatment failure was defined as the persistence of a positive culture at 48 hours or the need for hospital admission for intravenous rehydration or antibiotic therapy.


RESULTS
Sixty-nine children were enrolled, 34 in the IM + PO group and 35 in the PO group. The 2 groups were similar at the initial visit with respect to age, sex, clinical degrees of illness, white blood cell count, and erythrocyte sedimentation rate (P>.05). At the 48-hour follow-up visit, there were no differences between the 2 treatment groups in resolution of vomiting, fever, general appearance, abdominal tenderness, and hydration state (P>.05). There were 9 treatment failures, 4 in the IM + PO group and 5 in the PO group (P =.93).


CONCLUSIONS
The addition of a single dose of intramuscular ceftriaxone to a 10-day course of oral trimethoprim-sulfamethoxazole for urinary tract infection with fever resulted in no difference at 48 hours in the urine sterilization rate, degree of clinical improvement, or subsequent hospital admission rate.
Baker
P C
PC
101 Marion Ave, Sausalito, CA 94965, USA. suzannaz@pacbell.net
Nelson
D S
DS
Schunk
J E
JE
D000284:Administration, Oral; D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D002443:Ceftriaxone / Q000008:administration & dosage / Q000627:therapeutic use*; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005334:Fever / Q000188:drug therapy; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D017063:Outcome Assessment, Health Care; D016037:Single-Blind Method; D017211:Treatment Failure; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use; D014552:Urinary Tract Infections / Q000188:drug therapy*
D000892:Anti-Infective Agents, Urinary; D002511:Cephalosporins; D002443:Ceftriaxone; D015662:Trimethoprim, Sulfamethoxazole Drug Combination