Should antibiotics be stopped in adults when a urine culture is negative?
Although urine culture is currently regarded as the gold standard for diagnosis of UTI (albeit often retrospectively), midstream-voided urine colony counts are an imperfect diagnostic criterion for UTI. Contamination and colony counts below the laboratory’s threshold for reporting can both lead to a “negative” culture for a patient who actually has a symptomatic UTI. The most important limitation of urine cultures from a stewardship perspective is that culture results in themselves tell us nothing about whether the patient has urinary symptoms (and thus true UTI) or symptoms unrelated to the urinary tract.
Also, recent research has shown that that almost all females with typical urinary complaints and a negative culture still have an infection with E. coli.
What is the preferred antibiotic treatment for children (infants older than one month and young children) with Urinary Tract Infection?
A cephalosporin as the first-line oral agent in the treatment of UTI in children without genitourinary abnormalities.
The predicted probability of resistance to first-generation cephalosporins, trimethoprim-sulfamethoxazole, or amoxicillin is relatively high, and the tissue concentrations of nitrofurantoin may not be adequate to eradicate the causative organism.
– Cefixime 8 mg/kg once daily
– Cefdinir 14 mg/kg by mouth once daily
– Ceftibuten 9 mg/kg by mouth once daily
– Cefpodoxime 10 mg/kg per day by mouth divided in two doses, but no large trials have specifically evaluated the efficacy of cefpodoxime for pediatric UTI
Length of treatment: Longer course of therapy for febrile children (usually 10 days) and a short course of therapy (three to five days) for immune-competent children presenting without fever.
Source: UpToDate
