SAN DIEGO— Empiric cephalexin for the treatment of outpatient urinary tract infection (UTI) in children results in fewer treatment failures than trimethoprim-sulfamethoxazole (TMP-SMX) or amoxicillin, researchers concluded in a presentation in IDWeek.

A team at the Children’s Hospital of Philadelphia led by Jonathan M. Beus, MD, MS, studied 2,134 children presenting to 27 pediatric primary care practices or the emergency department with a positive urine culture, pyuria, and signs or symptoms consistent with UTI (fever, dysuria, abdominal or flank pain, urgency, or frequency; in children aged 2 years or younger, feeding difficulties, fussiness, or vomiting).

Of the 2,134 patients, 761 received empiric cephalexin, 1,010 received TMP-SMX, and 363 received amoxicillin. Treatment failure—defined as a switch to an alternate antibiotic within 15 days of urine culture—occurred in 13%, 19%, and 36% of patients, respectively. In adjusted analyses, cephalexin treatment was associated with a 33% decreased risk of treatment failure compared with TMP-SMX. Additionally, among cephalexin-treated patients who had a pathogen susceptible to cefazolin or cephalothin, 96% had treatment success, which was similar to the 95% success rate observed in patients treated with TMP-SMX who had pathogens susceptible to these antibiotics.

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“Although no direct standard for susceptibility to cephalexin exists, susceptibility to first generation cephalosporins appears to be predictive of treatment success,” Dr. Beus’ group concluded in a study abstract.