William T. Basco, Jr, MD, MS
In a world consumed by fear of a virus, the damage done as a result of inappropriate antibiotic use and the subsequent increase in antimicrobial resistance has taken a back seat. But that does not mean that the need for good antibiotic stewardship has gone away. Here are a few key studies published in the past few months about antibiotic use in kids that should affect our decision-making.
Treating UTIs
The initial choice of an antibiotic to treat a child with a suspected urinary tract infection (UTI) based on history, clinical picture, and screening labs is empirical. And sometimes the first choice is wrong. Are children who receive a "discordant" antibiotic (one to which the isolate was not ultimately deemed sensitive) ultimately hurt?
A recent study analyzed data from over 300 children (mostly outpatients) with UTIs with bacterial isolates later determined to be resistant to third-generation cephalosporins. Although over 90% of these children were initially treated with cephalexin(narrow-spectrum approach), only 2.2% of them required escalation of care. In addition to the very low rate of treatment failure overall, the large majority (85%) improved clinically. It's worth emphasizing that children with complex medical conditions other than urologic conditions were excluded, and the majority of these patients were well enough to not be admitted in the first place. However, the results demonstrate that even when concerned about a UTI in a patient, we can still begin narrow-spectrum antibiotics while awaiting culture results.
