Empirical antibiotic therapy for acute cystitis in children
For information on management of UTI in neonates and children younger than 3°months, see Urinary tract infection in neonates and children younger than 3 months.
Consider the child’s ability to swallow tablets or capsules and the availability and palatability of a formulation suitable for the child’s age (eg commercially available oral liquid formulation) when selecting an appropriate oral antibiotic. See Approach to empirical antibiotic choice for UTI in children for principles of antibiotic choice.
For empirical therapy for acute cystitis in children 3°months or older who can swallow tablets or capsules, while awaiting the results of culture and susceptibility testing, use:
1nitrofurantoin orally, 6-hourly for 5 days1 nitrofurantoin
child 29 kg to 50 kg: 50 mg
child more than 50 kg: 100 mg
OR
2trimethoprim orally, for 3 days2 3 trimethoprim
child 38 kg to 50 kg: 150 mg 12-hourly
child more than 50 kg: 300 mg once daily.
For empirical therapy for acute cystitis in children 3°months or older who cannot swallow tablets or capsules, while awaiting the results of culture and susceptibility testing, useNational Institute for Health and Care Excellence (NICE), October 2018Stein, 2015:
1cefalexin 12.5 mg/kg up to 500 mg orally, 6-hourly for 3 days cefalexin
OR if adherence to a 6-hourly regimen is unlikely
1cefalexin 20 mg/kg up to 750 mg orally, 8-hourly for 3 days4 cefalexin
OR
2trimethoprim+sulfamethoxazole (child 1 month or older) 4+20 mg/kg up to 160+800 mg orally, 12-hourly for 3 days2trimethoprim + sulfamethoxazole
OR (if a suitable trimethoprim formulation is available)
2trimethoprim 4 mg/kg up to 150 mg orally, 12-hourly for 3 days23.trimethoprim
If culture and susceptibility testing indicate the pathogen is resistant to empirical therapy, do not modify therapy if symptoms of cystitis are improving.
If the pathogen is resistant to empirical therapy and symptoms of cystitis are not improving, use the narrowest spectrum antibiotic to which the pathogen is susceptible.
For children with ongoing cystitis symptoms following appropriate antibiotic therapy, seek expert advice.
Do not perform post-treatment urine culture to confirm resolution of infection for asymptomatic children.