The absence of urinary nitrites predicts potential resistance of pediatric UTIs to cephalosporins, according to investigators at the Children’s Hospital of Western Ontario, London, Ont., Canada.

They retrospectively studied 173 pediatric patients who were diagnosed with a clinical UTI in an emergency department and had a positive urine culture and a recorded dipstick at the time of their visit.


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A review of the data showed that 1.4% of nitrite-positive UTIs were resistant to third-generation cephalosporins compared with 14.4% of nitrite-negative UTIs.


For first-generation cephalosporins, 8.4% were resistant in the nitrite-positive group vs. 22.2% in the nitrite-negative group, researchers reported in The Journal of Emergency Medicine (2008; published online ahead of print).

“Due to low levels of pediatric UTI resistance,” the authors concluded, “cephalosporins continue to represent useful empiric therapy in the general pediatric population. However, in high-risk patients, physicians may opt to alter their empiric choice of antibiotic based on the presence of urinary nitrites.