Intravenous antibiotic therapy for acute pyelonephritis in children
For advice on management of urinary tract infection (UTI) in neonates and children younger than 3 months, see Urinary tract infection in neonates and children younger than 3 months.
For children with sepsis or septic shock, see Sepsis and septic shock from a urinary tract source in children for management.
See Approach to managing acute pyelonephritis in children for a discussion of antibiotic choice.
For empirical intravenous therapy for acute pyelonephritis in children 3 months or older, useNational Institute for Health and Care Excellence (NICE), October 2018Stein, Dogan, Hoebeke, Kocvara, Nijman, Radmayr, Tekgul, European Association of, 2015Strohmeier, 2014:
1gentamicin 7 mg/kg up to 560 mg intravenously for initial dose1; see Principles of aminoglycoside use for prescribing considerations and subsequent dosing. See advice on modification and duration of therapy gentamicin
OR
1tobramycin 7 mg/kg up to 560 mg intravenously for initial dose1; see Principles of aminoglycoside use for prescribing considerations and subsequent dosing. See advice on modification and duration of therapy. tobramycin
Ceftriaxone or cefotaxime may be used for children in whom intravenous therapy is likely to continue for 72 hours or longer2, to avoid the need to switch to a non–aminoglycoside-containing regimen at 72 hours. Ceftriaxone or cefotaxime is also recommended if the patient has contraindications or precautions that preclude aminoglycoside use. For empirical intravenous therapy for acute pyelonephritis in children 3 months or older, use:
1ceftriaxone 50 mg/kg up to 1 g intravenously, daily. See advice on modification and duration of therapy ceftriaxone
OR
1cefotaxime 50 mg/kg up to 1 g intravenously, 8-hourly. See advice on modification and duration of therapy. cefotaxime
For children who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, any of the above regimens can be used.
For children who have had a severe immediate3 hypersensitivity reaction to a penicillin, ceftriaxone or cefotaxime (as above) can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).
For children who have had a severe immediate3 hypersensitivity reaction to a penicillin in whom ceftriaxone or cefotaxime is not used, or for children who have had a severe delayed4 hypersensitivity reaction to a penicillin, use gentamicin or tobramycin (as above) and seek expert advice.
For children managed in an emergency department, short-stay ward or urgent care centre who already have an intravenous access device in place, giving a single dose of an intravenous antibiotic and discharging the child on oral therapy once clinically improved can be a useful strategy.