Antimicrobial treatment of urinary tract infections in children.

Urinary tract infections are the most frequent documented bacterial infections in children. The antibiotic choices proposed in this manuscript are based on the guidelines published by the Pediatric Infectious Disease Group (GPIP) and the French-Language Infectious Disease Society (SPILF). Dipstick positive for leukocytes and/or nitrites must precede in most circumstances (excluding the newborns, neutropenic patients and those with sepsis), urine culture and antibiotic prescription. The proportion of extended-spectrum β-lactamase (ESBL) Escherichia coli strains has increased steadily in recent years, and the situations in which oral antibiotic switch is frequently not available are increasing. Cephalosporin resistance remains below 10% in most regions of France. However, there is no doubt that the proportion of resistant strains will increase in the coming years: the only uncertainly concerns the speed of this trend. With the aim of saving penems and promoting outpatient care, this guide proposes among the acceptable initial treatments for febrile urinary tract infections in infants, amikacin. This aminoglycoside remains active against the majority of ESBL strains and can be prescribed in once-daily dose allowing also ambulatory management of patients from pediatric emergency department.