Outpatient Management of Febrile Urinary Tract Infection in Children as Effective as Inpatient Settings

Outpatient Management of Febrile Urinary Tract Infection in Children as Effective as Inpatient Settings
Date: 5/30/2009

TUMSPR News: Outpatient parenteral antimicrobial therapy in children with febrile urinary tract infection is the title of research carried out at Bahrami Children’s Hospital. (H)

In a report dispatched by the Public Relations Office of Bahrami Children's Hospital, doctors Daryouh Fahimi, Peyman Salamati and Rasoul Nasiri Kalmarzi have evaluated 203 children out of which, 99 cases had been in outpatient and 104 in inpatient settings. The subjects had been 3 months to 15 years of age and had been presented with fever and urinary tract infection. Both groups had been similar in regards to demographic data and clinical and laboratory characteristics.

The researchers have compared the efficacy of two-day intravenous ceftriaxone (75 mg/kg/day) followed by an oral cefixime (4 mg/kg/twice daily) for 8 days for the outpatient group versus the 4-day intravenous ceftriaxone (75 mg/kg/daily divided by two) followed by oral cefixim (4mg/kg/twice daily) for 6 days for the inpatient group. Bacteremia was present in 6% of children on the outpatient and 4.8% on the inpatient groups (P=NS).

Regarding short-term outcomes (sterilization of the urine and defervescence), repeated urine cultures were sterile in 48 hours in all children upon the initial treatment and mean time for defervscence was 27 hours for children on outpatient and 31 hours for those on inpatient groups (P=NS). In long-term outcomes (incidence of reinfection and renal scarring documented by Tc 99m dimercaptosuccinic acid (DMSA) scintigraphy): reinfection occurred in 9.1% of the outpatient and 13.4% in the inpatient groups (P=NS) while renal scarring developed in 11% of the outpatient and 7.6%. of the inpatient groups (P=NS).

This study shows there is no significant difference between two treatment settings regarding renal scarring (P=NS). It seems that intravenous ceftriaxone for 2 days followed by oral cefixime for the completion of a-10 course could be recommended in outpatient settings, as a safe and effective treatment for children with febrile urinary tract infection.

http://publicrelations.tums.ac.ir/english/news/detail.asp?newsID=12129