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.
“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.