Approach to empirical antibiotic choice for UTI in children

In addition to the factors described in Approach to empirical antibiotic choice for UTI in adults, antibiotic choice for urinary tract infection (UTI) in children also depends on the age of the child, likely aetiology of infection, ease of drug administration and a consideration of the risk of adverse outcomes from clinical failure.

For neonates and children younger than 3 months, see Urinary tract infection in neonates and children younger than 3 months.

For children 3 months or older, the considerations for the choice of empirical antibiotic therapy for UTI are the same as those for adults, but there is a lower threshold for starting treatment with intravenous antibiotics in the first 6 months of life.

Specific information regarding the rationale for empirical antibiotic choice in children with UTI is given for acute cystitis and acute pyelonephritis.

If available, the results of recent culture and susceptibility testing may help to guide empirical antibiotic choice. For children that develop UTI while taking antibiotic prophylaxis, seek expert advice.

There is worldwide emergence of multidrug-resistant Escherichia coli, particularly strains producing extended-spectrum beta-lactamases (ESBLs). In Australia, UTI caused by ESBL-producing strains of E. coli remains uncommon in children. Consider if the child is at increased risk of a UTI caused by multidrug-resistant gram-negative bacteria.