D. Prais, R.
Straussberg, Y. Avitzur, J. Amir
Schneider Children's Medical Center of Israel
Introduction: Emerging
resistance to common oral antibiotics in urinary tract infections (UTI) is not
unusual. The aim of this study was to assess the community-acquired UTI
antibiotic susceptibility in children.
Methods: Patients with a
first community-acquired UTI diagnosed by properly collected urine specimen
were studied. Two different groups were evaluated: 142 patients enrolled during
1991-92 compared to 120 children enrolled during 1998-99.
Results: The pathogens
recovered in the two groups were similar. In 1991-92: E-Coli 86%; Klebsiella
6%; others 8%. In 1998-99: E-Coli 82%; Klebsiella 13%; others 5%.
|
Antibiotic Sensitivity |
||||||
|
|
E-Coli |
Klebsiella |
Total |
|||
|
|
1991 |
1999 |
1991 |
1999 |
1991 |
1999 |
|
Ampicillin |
37% |
32% |
1% |
7% |
33% |
30% |
|
Amoxi-Clavulonate |
N.D. |
78% |
N.D. |
78% |
N.D. |
76% |
|
Cephalexin |
90% |
64% |
50% |
71% |
82% |
63% |
|
Cefuroxime |
N.D. |
99% |
N.D. |
78% |
N.D. |
97% |
|
Nalidixic Acid |
98% |
98% |
100% |
93% |
97% |
98% |
|
Nitrofurantoin |
100% |
98% |
89% |
73% |
93% |
92% |
|
Cotrimoxazole |
59% |
67% |
67% |
78% |
60% |
69% |
Overall
resistance to antibiotics in 1999 was: ampicillin 70%; amoxi-clavulonate 24%;
cephalexin 37%; cefuroxime 3%; nitrofurantoin 8%; nalidixic acid 3%;
cotrimoxazole 31%.
Conclusion: Empirical
treatment with cotrimoxazole or cephalexin as initial drug is inadequate in
approximately one third of UTI cases. We propose cefuroxime-axetil as the drug
of choice for oral empirical treatment of community-acquired UTI in children.