Amoxycillin and Clavulanic Acid in the Treatment of Urinary Tract Infections in Children

1989 ◽  
Vol 17 (2) ◽  
pp. 168-171 ◽  
Author(s):  
U. Ruberto ◽  
P. D'Eufemia ◽  
F. Martino ◽  
O. Giardini

The efficacy of amoxicillin–clavulanic acid combination in the treatment of urinary tract infections resistant, in vitro, to amoxycillin was studied in 42 children. Of the 24 children with urinary tract infection for the first time, combination therapy, dosing twice daily for 5 days (40 mg/kg·day), cleared the infection in 23 (96%) cases. Relapse occurred in four (17%) cases within 30 days. Of the 18 children who presented with recurrent urinary tract infections therapy, as above, cleared the infection in 16 (89%) cases. In these cases, long-term therapy was performed at a dosage of 20 mg/kg once daily. Tolerance was good; gastro-intestinal disorders in five (12%) cases which regressed by dosing at 8 h rather than 12 h intervals. In conclusion, amoxycillin–clavulanic acid can be considered a first choice treatment of urinary tract infections in children.

Author(s):  
Rian Lelie- van der Zande ◽  
Marcel Bouvy ◽  
Martina Teichert

Abstract Aim: To study whether changes in drug preferences in the Dutch guideline for the treatment of Urinary Tract Infection (UTI) for General Practitioners (GPs) in 2013, resulted in corresponding changes in antibiotic dispensing. Background: For the treatment of uncomplicated UTI, nitrofurantoin remained the first choice, while fosfomycin became the second choice and changed ranks with trimethoprim. For a subsequent febrile UTI, ciprofloxacin became the first choice and changed ranks with amoxicillin/clavulanic acid, co-trimoxazole remained the third choice. Methods: In this observational cross-sectional study, routinely collected dispensing data from the Dutch Foundation of Pharmaceutical Statistics from 2012 to 2017 were used. The number of women 18 years and older, treated with one of the guideline antibiotics for uncomplicated UTI and subsequent febrile UTI were analysed annually. Proportions were calculated. Data were stratified for age categories. Failure of uncomplicated UTI treatment was defined as the dispensing of an antibiotic for febrile UTI within 14 days after the dispensing of an antibiotic for uncomplicated UTI. Findings: Data were available from 81% of all pharmacies in 2012 to 89% in 2017. Percentages of women dispensed nitrofurantoin were relatively stable with 87.4% in 2012 and 84.4% in 2017. Percentages of women dispensed fosfomycin increased from 5.4% in 2012 to 21.8% in 2017, whereas percentages of women dispensed trimethoprim decreased from 17.8% to 8.0%. Within age categories, the percentage of women dispensed fosfomycin increased from 12.4% in women 18–30 years old to 36.7% in women above 80 years old. Percentages of women dispensed antibiotics for febrile UTI remained stable at 5% annually. Percentages of women receiving ciprofloxacin increased from 1.9% in 2012 to 3.3% in 2017, while those receiving amoxicillin/clavulanic acid decreased from 2.9% to 1.8%. New guideline recommendations resulted in corresponding changes in dispensed antibiotics for uncomplicated UTI and subsequent febrile UTI. Drug choices differed for age categories.


Author(s):  
Mengistu Abayneh ◽  
Getnet Tesfaw ◽  
Alemseged Abdissa

Background. Klebsiella pneumoniae and Escherichia coli are the major extended-spectrum β-lactamase- (ESBL-) producing organisms increasingly isolated as causes of complicated urinary tract infections and remain an important cause of failure of therapy with cephalosporins and have serious infection control consequence. Objective. To assess the prevalence and antibiotics resistance patterns of ESBL-producing Escherichia coli and Klebsiella pneumoniae from community-onset urinary tract infections in Jimma University Specialized hospital, Southwest Ethiopia, 2016. Methodology. A hospital-based cross-sectional study was conducted, and a total of 342 urine samples were cultured on MacConkey agar for the detection of etiologic agents. Double-disk synergy (DDS) methods were used for detection of ESBL-producing strains. A disc of amoxicillin + clavulanic acid (20/10 µg) was placed in the center of the Mueller–Hinton agar plate, and cefotaxime (30 µg) and ceftazidime (30 µg) were placed at a distance of 20 mm (center to center) from the amoxicillin + clavulanic acid disc. Enhanced inhibition zone of any of the cephalosporin discs on the side facing amoxicillin + clavulanic acid was considered as ESBL producer. Results. In the current study, ESBL-producing phenotypes were detected in 23% (n = 17) of urinary isolates, of which Escherichia coli accounts for 76.5% (n = 13) and K. pneumoniae for 23.5% (n = 4). ESBL-producing phenotypes showed high resistance to cefotaxime (100%), ceftriaxone (100%), and ceftazidime (70.6%), while both ESBL-producing and non-ESBL-producing isolates showed low resistance to amikacin (9.5%), and no resistance was seen with imipenem. In the risk factors analysis, previous antibiotic use more than two cycles in the previous year (odds ratio (OR), 6.238; 95% confidence interval (CI), 1.257–30.957; p = 0.025) and recurrent UTI more than two cycles in the last 6 months or more than three cycles in the last year (OR, 7.356; 95% CI, 1.429–37.867; p = 0.017) were found to be significantly associated with the ESBL-producing groups. Conclusion. Extended-spectrum β-lactamases- (ESBL-)producing strain was detected in urinary tract isolates. The occurrence of multidrug resistance to the third-generation cephalosporins, aminoglycosides, fluoroquinolones, trimethoprim-sulfamethoxazole, and tetracyclines is more common among ESBL producers. Thus, detecting and reporting of ESBL-producing organisms have paramount importance in the clinical decision-making.


2014 ◽  
Vol 27 (6) ◽  
pp. 737 ◽  
Author(s):  
Rui Passadouro ◽  
Raquel Fonseca ◽  
Felícia Figueiredo ◽  
Andreia Lopes ◽  
Cristina Fernandes

<strong>Introduction:</strong> The urinary tract infections, after respiratory infections, are the most common in the community. The knowledge about the prevalence of microbial strains and their antibiotic susceptibility is crucial to establish an effective empirical therapy. The aim of this study was to determine the antibiotic susceptibility patterns of bacterial strains isolated from positive urine cultures performed in patients from the central region of Portugal.<br /><strong>Material and Methods:</strong> We carried out a documental analysis of 6008 urine bacteriological exams, to be made available to physicians, most of which run through the automated system VITEK 2, bioMérieux. The majority (80%) of the urine bacteriological exams were from female. Escherichia coli was the most prevalent bacterial pathogen (65.9%), followed by Klebsiella spp (12%).<br /><strong>Results:</strong> Nitrofurantoin showed high levels of activity (96%) for Escherichia coli, as well as Fosfomycin (96.6%). Amoxicillin-clavulanic acid presents an activity level of only 81.1% for the same germ. Quinolones exhibit efficacy to only 78% of the strains of Escherichia coli, below the Fosfomycin and Nitrofurantoin. Nitrofurantoin showed high levels of activity (96%) for E. coli as well as Fosfomycin (96.6%). Amoxicillin-Clavulanic Acid presents a level of activity of only 81.1% for the same germ. The quinolones have a efficacy for only 78% of strains of E. coli, lower than Fosfomycin.<br /><strong>Discussion:</strong> Escherichia Coli was the most prevalent uropathogen (65.9%). High efficacy against this pathogenic agent was found for Fosfomycin (96.6%) and Nitrofurantoin (96%).<br /><strong>Conclusion:</strong> Further antimicrobial surveillance studies should be developed, in order to formulate local empirical therapy<br />recommendations for optimized therapeutical choices.<br /><strong>Keywords:</strong> Urinary Tract Infections; Drug Resistance, Bacterial; Anti-Bacterial Agents; Community-Acquired Infections.<br />


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