title: Susceptibility of recent bacterial isolates to cefdinir and selected antibiotics among children with urinary tract infections.
abstract: BACKGROUND
  Cefdinir, an extended-spectrum cephalosporin administered orally, is approved by the U.S. Federal Drug Administration for treatment of skin and respiratory tract infections. During the last two years at the authors' institution, this agent has been used as an off-label treatment for urinary tract infections in children.
  
  
  OBJECTIVE
  To evaluate antimicrobial susceptibility testing data in children to determine whether there is support for this prescribing practice.
  
  
  METHODS
  In this retrospective study (2003-2004), the authors compared the susceptibility patterns of urinary pathogens to cefdinir and selected antibiotics in children who were evaluated for urinary tract infections in an urban tertiary academic pediatric emergency department. Pathogens (community acquired vs. opportunistic or nosocomial) were categorized as susceptible, indeterminate, or resistant on the basis of antibiotic susceptibility breakpoints. The frequency of these categorizations for individual drugs was determined.
  
  
  RESULTS
  Seven hundred five isolates were recovered from urine during the study period. Pathogens isolated most frequently were Escherichia coli, Klebsiella spp, and Proteus spp. Of 431 isolates retained in the data set, 412 (95.6%) were susceptible to cefdinir. This rate was comparable or superior to rates observed for other antibiotics: 49.4% for ampicillin, 84.9% for trimethoprim-sulfamethoxazole, 88.4% for cefazolin, 93.3% for nitrofurantoin, 94.2% for ticarcillin-clavulanate potassium, 97.5% for gentamicin, and 97.7% for ceftriaxone. Cefdinir, however, had lower activity (64.7%) against 17 bacterial isolates categorized as opportunistic or nosocomial pathogens.
  
  
  CONCLUSIONS
  Cefdinir provides good coverage against common pathogens responsible for urinary tract infections in children and compares favorably with other oral and parenteral antibiotics that are used in the empiric treatment of this infection.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, Children's Hospital, Columbus, OH 43205, USA. bonsub@pediatrics.ohio-state.edu
authors.forename: Bema K
authors.initials: BK
authors.lastname: Bonsu
authors.forename: Lori
authors.initials: L
authors.lastname: Shuler
authors.forename: Laura
authors.initials: L
authors.lastname: Sawicki
authors.forename: Pam
authors.initials: P
authors.lastname: Dorst
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Cohen
mesh_terms: D000284:Administration, Oral; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D000890:Anti-Infective Agents / Q000494:pharmacology*; D001419:Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D000077525:Cefdinir; D002511:Cephalosporins / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology / Q000652:urine; D005260:Female; D006801:Humans; D007223:Infant; D007263:Infusions, Parenteral; D008297:Male; D008826:Microbial Sensitivity Tests / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology* / Q000652:urine; D014556:Urine / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D002511:Cephalosporins; D000077525:Cefdinir