Best oral empirical treatment for pyelonephritis in children: Do we need to differentiate between age and gender?
BACKGROUND
Pyelonephritis is a common infection in childhood and may cause renal scarring. The aim was to determine an effective oral antibiotic treatment of first time pyelonephritis in children.


METHODS
The study is a retrospective analysis of positive urine cultures collected at a Danish paediatric department from 2010-2013. Urine samples from 378 children aged 0-15.9 years, without renal anomalies and treated for first time pyelonephritis, were included. The urine pathogens and antimicrobial susceptibilities were analysed.


RESULTS
The most common aetiologic agents found were Escherichia coli (85%), Klebsiella species and other Enterobacteriaecea (9.7%) and Enterococcus species (5.3%). Escherichia coli was significantly more common in girls than in boys (90% vs 74%, p < 0.001) and in children older than 6 months (89% vs 77%, p < 0.001). Children younger than 6 months had a higher prevalence of other Gram-negative rods (16% vs 7%, p < 0.001). These differences may be due to boys representing 63% of patients in the youngest age group compared to 16% of older children (p < 0.001). For all urine isolates, piv-mecillinam and amoxicillin-clavulanate had the lowest resistance rates of 6.9% and 7.2%, respectively, and 6% for both antimicrobials in patients older than 6 months. Uropathogens from boys above 6 months of age were more resistant to piv-mecillinam compared to girls (25% vs 2.4%, p < 0.001).


CONCLUSIONS
This study recommends piv-mecillinam or amoxicillin-clavulanate as empirical treatment of first time pyelonephritis in Danish children from 6 months of age. Age and gender of patients should be taken into consideration when initiating empirical treatment.
a Department of Paediatrics , Copenhagen University Hospital Hvidovre , Copenhagen , Denmark ;
Petra
P
Salomonsson
b Department of Paediatrics and Adolescent Medicine , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark ;
Marie-Louise
ML
von Linstow
c Department of Clinical Microbiology , Copenhagen University Hospital Hvidovre , Copenhagen , Denmark ;
Jenny Dahl
JD
Knudsen
a Department of Paediatrics , Copenhagen University Hospital Hvidovre , Copenhagen , Denmark ;
Ida
I
Heiberg
a Department of Paediatrics , Copenhagen University Hospital Hvidovre , Copenhagen , Denmark ;
Gylli
G
Mola
d Faculty of Health and Medical Sciences , University of Copenhagen , Denmark.
Therese Ramstad
TR
Wenger
a Department of Paediatrics , Copenhagen University Hospital Hvidovre , Copenhagen , Denmark ;|d Faculty of Health and Medical Sciences , University of Copenhagen , Denmark.
Dina
D
Cortes
b Department of Paediatrics and Adolescent Medicine , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark ;
Ulrikka
U
Nygaard
D000284:Administration, Oral; D000293:Adolescent; D000367:Age Factors; D000561:Amdinocillin Pivoxil / Q000008:administration & dosage / Q000494:pharmacology; D019980:Amoxicillin-Potassium Clavulanate Combination / Q000008:administration & dosage / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007709:Klebsiella / Q000187:drug effects / Q000302:isolation & purification; D008297:Male; D011704:Pyelonephritis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D012737:Sex Factors; D014556:Urine / Q000382:microbiology
D000900:Anti-Bacterial Agents; D000561:Amdinocillin Pivoxil; D019980:Amoxicillin-Potassium Clavulanate Combination
Pyelonephritis; age; amoxicillin-clavulanate; children; gender; oral antibiotic; paediatric