[Empirical antibiotic therapy for urinary tract infection in children. Analysis of three hundred patients admitted to a general hospital].

For more than 25 years, treatment of acute pyelonephritis in children has been the subject of debates. Recent publications (including of Cochrane database review) let think that oral antibiotics could be as safe as intravenous treatement at least regarding the major concerns of urinary infection: renal scaring, time to defervescence and sterilization of urine at 72 hours. To investigate if such a protocol could be applied in our country, we first determine the rate of bacterial resistance to oral antibiotics commercially available in Belgium. Antibiograms of 191 outpatients with a diagnosis of pyelonephritis show that neither amoxicillin, amoxicillin/clavulanate nor trimethoprim/sulphamethoxazol can be recommended as an empiric treatment of febrile urinary infection among children in our region. Only 80% of bacterial strains were sensitive to amoxicillin/clavulanate, a level far below the rate reported in literature in favour of oral treatment of acute pyelonephritis (> 90%). Cefuroxime seems to be a better candidate as first line therapy, however no clinical study supports its use.