title: Empiric antibiotic treatment for urinary tract infection in preschool children: susceptibilities of urine sample isolates.
abstract: BACKGROUND
  Antibiotic treatment recommendations based on susceptibility data from routinely submitted urine samples may be biased because of variation in sampling, laboratory procedures and inclusion of repeat samples, leading to uncertainty about empirical treatment.
  
  
  OBJECTIVE
  To describe and compare susceptibilities of Escherichia coli cultured from routinely submitted samples, with E. coli causing urinary tract infection (UTI) from a cohort of systematically sampled, acutely unwell children.
  
  
  METHODS
  Susceptibilities of 1458 E. coli isolates submitted during the course of routine primary care for children <5 years (routine care samples), compared to susceptibilities of 79 E. coli isolates causing UTI from 5107 children <5 years presenting to primary care with an acute illness [systematic sampling: the Diagnosis of Urinary Tract infection in Young children (DUTY) cohort].
  
  
  RESULTS
  The percentage of E. coli sensitive to antibiotics cultured from routinely submitted samples were as follows: amoxicillin 45.1% (95% confidence interval: 42.5-47.7%); co-amoxiclav using the lower systemic break point (BP) 86.6% (84.7-88.3%); cephalexin 95.1% (93.9-96.1%); trimethoprim 74.0% (71.7-76.2%) and nitrofurantoin 98.2% (97.4-98.8%). The percentage of E. coli sensitive to antibiotics cultured from systematically sampled DUTY urines considered to be positive for UTI were as follows: amoxicillin 50.6% (39.8-61.4%); co-amoxiclav using the systemic BP 83.5% (73.9-90.1%); co-amoxiclav using the urinary BP 94.9% (87.7-98.4%); cephalexin 98.7% (93.2-99.8%); trimethoprim 70.9% (60.1-80.0%); nitrofurantoin 100% (95.3-100.0%) and ciprofloxacin 96.2% (89.4-98.7%).
  
  
  CONCLUSIONS
  Escherichia coli susceptibilities from routine and systematically obtained samples were similar. Most UTIs in preschool children remain susceptible to nitrofurantoin, co-amoxiclav and cephalexin.
authors.affiliation: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Cwm Taf University Health Board, Abercynon, christopher.butler@phc.ox.ac.uk.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Butler
authors.affiliation: Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS.
authors.forename: Kathryn
authors.initials: K
authors.lastname: O'Brien
authors.affiliation: Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff.
authors.forename: Mandy
authors.initials: M
authors.lastname: Wootton
authors.affiliation: Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff.
authors.forename: Timothy
authors.initials: T
authors.lastname: Pickles
authors.affiliation: South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS.
authors.forename: Kerenza
authors.initials: K
authors.lastname: Hood
authors.affiliation: Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital Wales, Heath Park, Cardiff.
authors.forename: Robin
authors.initials: R
authors.lastname: Howe
authors.affiliation: South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS.
authors.forename: Cherry-Ann
authors.initials: CA
authors.lastname: Waldron
authors.affiliation: South East Wales Trials Unit (SEWTU), Centre for Trials Research, Cardiff University, 7th Floor Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS.
authors.forename: Emma
authors.initials: E
authors.lastname: Thomas-Jones
authors.affiliation: Bristol Royal Hospital for Children, University Hospitals Bristol, NHS Foundation Trust, Bristol.
authors.forename: Jan
authors.initials: J
authors.lastname: Dudley
authors.affiliation: Department of Paediatrics and Child Health, University Hospital of Wales, Cardiff.
authors.forename: Judith
authors.initials: J
authors.lastname: Van Der Voort
authors.affiliation: Primary Care and Population Sciences Division, University of Southampton, Southampton and.
authors.forename: Kate
authors.initials: K
authors.lastname: Rumsby
authors.affiliation: Primary Care and Population Sciences Division, University of Southampton, Southampton and.
authors.forename: Paul
authors.initials: P
authors.lastname: Little
authors.affiliation: Centre for Academic Primary Care, NIHR School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Harriet
authors.initials: H
authors.lastname: Downing
authors.affiliation: Primary Care and Population Sciences Division, University of Southampton, Southampton and.
authors.forename: Kim
authors.initials: K
authors.lastname: Harman
authors.affiliation: Centre for Academic Primary Care, NIHR School of Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol, UK.
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Hay
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002675:Child, Preschool; D004352:Drug Resistance, Microbial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008826:Microbial Sensitivity Tests; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000188:drug therapy*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibacterial agents; antibiotic resistance; diagnosis; paediatrics; surveillance; treatment recommendations; urinary tract infections.