Best oral empirical treatment for pyelonephritis in children: Do we need to differentiate between age and gender?

Petra Salomonsson; Marie-Louise von Linstow; Jenny Dahl Knudsen; Ida Heiberg; Gylli Mola; Therese Ramstad Wenger; Dina Cortes; Ulrikka Nygaard

doi:10.3109/23744235.2016.1168937

Best oral empirical treatment for pyelonephritis in children: Do we need to differentiate between age and gender?

Petra Salomonsson, Marie-Louise von Linstow, Jenny Dahl Knudsen, Ida Heiberg, Gylli Mola, Therese Ramstad Wenger, Dina Cortes, Ulrikka Nygaard

Department of Clinical Medicine

9 Citations (Scopus)

Abstract

Abstract: 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). Conclusion: 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.

Original language	English
Journal	Infectious Diseases
Volume	48
Issue number	10
Pages (from-to)	721-725
Number of pages	5
ISSN	2374-4235
DOIs	https://doi.org/10.3109/23744235.2016.1168937
Publication status	Published - 2 Oct 2016

Keywords

Administration, Oral
Adolescent
Age Factors
Amdinocillin Pivoxil
Amoxicillin-Potassium Clavulanate Combination
Anti-Bacterial Agents
Bacterial Infections
Child
Child, Preschool
Denmark
Drug Resistance, Bacterial
Enterococcus
Escherichia coli
Female
Hospitals, Pediatric
Humans
Infant
Infant, Newborn
Klebsiella
Male
Pyelonephritis
Retrospective Studies
Sex Factors
Urine
Journal Article

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10.3109/23744235.2016.1168937

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@article{f4150d381db94621b12ddcedde7f6609,

title = "Best oral empirical treatment for pyelonephritis in children: Do we need to differentiate between age and gender?",

abstract = "Abstract: 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). Conclusion: 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.",

keywords = "Administration, Oral, Adolescent, Age Factors, Amdinocillin Pivoxil, Amoxicillin-Potassium Clavulanate Combination, Anti-Bacterial Agents, Bacterial Infections, Child, Child, Preschool, Denmark, Drug Resistance, Bacterial, Enterococcus, Escherichia coli, Female, Hospitals, Pediatric, Humans, Infant, Infant, Newborn, Klebsiella, Male, Pyelonephritis, Retrospective Studies, Sex Factors, Urine, Journal Article",

author = "Petra Salomonsson and {von Linstow}, Marie-Louise and Knudsen, {Jenny Dahl} and Ida Heiberg and Gylli Mola and Wenger, {Therese Ramstad} and Dina Cortes and Ulrikka Nygaard",

year = "2016",

month = oct,

day = "2",

doi = "10.3109/23744235.2016.1168937",

language = "English",

volume = "48",

pages = "721--725",

journal = "Infectious Diseases",

issn = "2374-4235",

publisher = "Taylor & Francis",

number = "10",

}

TY - JOUR

T1 - Best oral empirical treatment for pyelonephritis in children

T2 - Do we need to differentiate between age and gender?

AU - Salomonsson, Petra

AU - von Linstow, Marie-Louise

AU - Knudsen, Jenny Dahl

AU - Heiberg, Ida

AU - Mola, Gylli

AU - Wenger, Therese Ramstad

AU - Cortes, Dina

AU - Nygaard, Ulrikka

PY - 2016/10/2

Y1 - 2016/10/2

N2 - Abstract: 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). Conclusion: 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.

AB - Abstract: 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). Conclusion: 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.

KW - Administration, Oral

KW - Adolescent

KW - Age Factors

KW - Amdinocillin Pivoxil

KW - Amoxicillin-Potassium Clavulanate Combination

KW - Anti-Bacterial Agents

KW - Bacterial Infections

KW - Child

KW - Child, Preschool

KW - Denmark

KW - Drug Resistance, Bacterial

KW - Enterococcus

KW - Escherichia coli

KW - Female

KW - Hospitals, Pediatric

KW - Humans

KW - Infant

KW - Infant, Newborn

KW - Klebsiella

KW - Male

KW - Pyelonephritis

KW - Retrospective Studies

KW - Sex Factors

KW - Urine

KW - Journal Article

U2 - 10.3109/23744235.2016.1168937

DO - 10.3109/23744235.2016.1168937

M3 - Journal article

C2 - 27300266

SN - 2374-4235

VL - 48

SP - 721

EP - 725

JO - Infectious Diseases

JF - Infectious Diseases

IS - 10

ER -

Best oral empirical treatment for pyelonephritis in children: Do we need to differentiate between age and gender?

Abstract

Keywords

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