This document provides information on drug therapy for urinary tract infections. It begins with learning objectives and an introduction on UTIs. It then discusses the epidemiology, etiology, clinical features, diagnosis, management and treatment of UTIs. Key points include that E. coli is the most common cause. Symptoms vary by age but may include fever, vomiting and lethargy in infants. Treatment involves antibiotics like cephalosporins, aminoglycosides and fluoroquinolones based on severity and location of infection. Complicated UTIs require hospitalization and IV antibiotics while uncomplicated cases can often be treated with oral medications. The duration of treatment typically ranges from 3-14 days depending on the specifics

1. DRUG THERAPY IN URINARY
TRACT INFECTION
Dr.Anoop
Resident pediatrics

2. LEARNING OBJECTIVES
• Introduction and Outline of UTI
• Age and clinical features specific approach.
• To diagnose complicated and uncomplicated
UTI.
• Treatment and drug therapy

3. INTRODUCTION
• UTI imply invasion of urinary tract by
pathogens,which may involve the upper or
lower tract depending on the infection in
the kidney,ureters or bladder and urethra.
• Common cause of morbidity that in a/w
abnormalities of the urinary tract,
contribute a long term complications,
including HTN and CRF.

4. EPIDEMIOLOGY
• Common bacterial infection in children.
• Non-specific signs and vague symptoms in very
young children,so may remain unrecognized.
• Commonest age for the occurrence of the first
symptomatic UTI in the first year of
life,particulerly in boys,when it mainly affects the
upper urinary tract.
• Approx Incidence in term-1 % and in preterms-3%
with M:F ratio of 5:1.
• During infancy risk of UTI is equal in boys and
girls and thereafter higher in girls.

5. • Risk of symptomatic UTI before the age 14
yr is 1-2% in boys 3-8% in girls.
• Risk is higher in children with
malnutrition and chronic diarrhoea.
• Obstructive lesions 10% boys
• VUR 30-40%
• Occurrence below 2yrs, delay in starting
treatment and presence of VUR or
obstruction are risk factors a/w RENAL
SCARRING.

6. ETIOLOGY
• 90% of first symptomatic UTI and 70% of
recurrent infections  E.coli.
• Proteus,klebsiella,staphylococcus epidermidis
and streptococcus faecalis occassionally
responsible
• Proteus and pseudomonas recurrent
UTI,instrumentation,and noscomial infections.
• Fungi i.e candida albicans common in
immunocompromised, preterm infants and
following prolonged antibiotic therapy.

7. Case scenario 1
• A 24 days male baby brought to the
emergency with chief complaints of
lethargy,unstable temperature, poor feeding
And feed intolerence.

8. APPROACH
 Sepsis screening- crp+ve
 Blood culture- no growth
 CSF analysis- normal
 Urine routine and culture
were sent.- growth of E.Coli
 Sensitive to cefotaxime
,ceftriaxone, amikacin.
 USG abdomen- normal
• Admission in NICU
• Parentral antibiotics
according to the hospital
protocol to begin with .
• Then changed according to
the sensitivity
• IV antibiotics for 10-14 days
continued
• In less than 3 months rule
out congenital conditions
• Repeat urine culture
usually not required

9. CLINICAL FEATURES IN NEONATES
AND INFANTS
• NEONATES
• Featurs of sepsis such as
lethargy,seizures,shock,unstable temperature
and persistance of physiolgical jaundice.
• Non specific symptoms including FTT, vomiting,
diarrhoea ,foul smelling urine.
• INFANTSunexplained fever may be the only
symptom of acute pyelonephritis In <2yrs.
• They are at higher risk of acute renal injury.

10. Case scenario 2
• A 10 yr old female with chief complaints of
• Increased frequency, urgency,
• abdominal pain, and cloudy urine.

11. APPROACH
• Urine routine and culture
along with other routine
investigations.
• USG abdomen –normal
• Urine pus cells -8-12/HPF
• Urine culture –growth of
E.coli.
• Sensitive to cefftriaxone ,
cefixime,Norfloxacin .
• Due to acute condition
the child admitted and
treated with IV(
ceftriaxone) antibiotics
for 3-4 days then as the
clinical condition
improved .
• Oral antibiotics for 3
days-- cefixime
acc to sensitivity.

12. HOW TO SUSPECT UTI?
A good clinical history and physical examination is
cornerstone in diagnosis of UTI with emphasis on
following points.
Age( all febrile infants<1 year)
Gender( male< 1 year, female>1 year)
Predisposing factors like bladder bowel
dysfunction, neurogenic bladder, anatomic
malformations of genitourinary system,voiding
dysfunction.
Clinical signs of upper or lower urinary tract
involvement.
Severity of illness.

13. CLINICAL FEATURES are variable
depending on age and site of
infection
age Most common to least common
Infancy 0-1 year High index of suspicion as symptoms
are nonspecific
Any infant with fever > 39*C should be
investigated for UTI.
Fever, vomiting,lethargy,irritability,poor
feeding, FTT,jaundice, hematuria
,offensive urine.
1-5 years Fever, abdominal pain, vomiting, loin
tenderness, hematuria, offensive urine
>5yrs Increase
frequency,dysuria,urgency,dysfunctional
voiding,abdominal pain, fever,
vomiting,hematuria, cloudy urine.

14. Number of bacteria required
Methods of collection Colony count Probability of infection
Suprapubic aspiration
(best method)
Any number of pathogen 99%
Transurethral
catheterisation(next best)
>5* 10^4 CFU/mL 95%
Mid stream clean catch >10^5CFU/mL 90-95%

15. MANAGEMENT
The goals of Treatment
• Elimination of infection and prevention of
urosepsis
• Prevention of recurrence and long-term
complications including hypertension, renal
scarring, and impaired renal growth and
function
• Relief of acute symptoms (eg, fever, dysuria,
frequency)

16. Clinical condition, route of
administration and duration of
treatment
Clinical condition Route of administration duration
Infants<3 months with
febrile/complicated UTI
parentral 10-14 days
Infants < 3 months with
lower urinary tract
involvement
parentral 7-10 days
Children > 3 months with
upper UTI
IV antibiotic for 2-4 days
followed by oral
antibiotics
10 days
Children > 3 months with
simple UTI.
Oral antibiotic 3 days
Breakthrough UTI As per culture-not higher
dose of same antibiotic
7-10 days
Asymptomatic bacteuria. No treatment

17. ANTIBIOTICS
DRUG DOSE(MG/KG/DAY) REMARKS
ORAL
AMOXICILLIN,COAMOXICLAV 30-50 in 2-3 divided doses Of choice for uncomplicated
UTI,risk of resistance
CEPHELEXIN 30-50 in 3 divided doses For uncomplicated UTI, not
effective againest proteus
CEFADROXIL 30-40 in 2 divided doses “
CEFIXIME 10 In 2 divided doses Broad spectrum agent
CIPROFLOXACIN 10-20 in 2 divided doses Avoid-<3m,G6PD def., lowers
seizure threshhold
PARENETRAL
GENTAMYCIN 5-6 in 1-2 divided doses Once daily dosing effective
AMIKACIN 15-20 in 1-2 divided doses Alone or combined with
ampicillin
CEFOTAXIME 100 in 2-3 divided doses Safe and convenient to use as
single medication
CEFTRIAXONE 75-100 in 2 divided doses “
AMPICILLIN Combine with aminiglycoside

18. Empirical choice of antibiotic for
UTI
DRUGS DOSES(mg/kg)
PARENTRAL
ceftriaxone 75-100 in 2 divided doses IV
cefotaxime 100-150 IN 2-3 divided doses IV
amikacin 10-15 single dose IV /IM
gentamicin 5-7 Single dose IV/IM
ORAL
cefixime 8-10 In 2 divided doses
coamoxiclav 30-35 of amoxy in 2 divided doses
ciprofloxacin 10-20 mg in 2 divided doses
Ofloxacin
cephalaxin
15-20 mgin 2 divided doses
50-70 in 2-3 divided doses

19. CEPHALOSPORINS
• FIRST GENERATION
 PARENTRAL
Cefazolin
 ORAL
Cephelexin
Cefadroxil
• SECOND GENERATION
 PARENTRAL
Cefuroxime
 ORAL
Cefaclor, cefuroxime axetil,
cefprozil
• THIRD GENERATION
 PARENTRAL
Cefotaxim
Ceftizoxime
Ceftriaxone
Ceftazidime
Cefoperazone
 ORAL
Cefixime
Cefopodoxime proxetil
Cefdinir
Cefibuten
Ceftamet pivoxil
FOURTH GENERATION
 PARENTRAL
Cefepime
Cefpirome

20. • CEFTRIAXONE:-
• Longer duration of
action (t1/2-8hr)
• CSF penetration is good
• Elimination equally in
urine and bile.
• High efficacy in a wide
range of serious
infections including
complicated UTI.
• s/e-hypersensitivity
reactions.
• Nephrotoxicity-low grade
• Dose- 50-75mg/kg/day
• CEFOTAXIME:-Potent
againest aerobic gram
negetive as well as some
gram positive bacteria
but no effect on
anerobes.
• Attains high CSF levels
• Dose- 50 mg/kg/dose in
neonates and infants bd
or tds.
• In older children 100-150
mg/kg/day in 2 or 3
divided doses.

21. • CEFIXIME:-
• Third generation
cephalosporin
• Orally active gainest
enterobacerecie,H.Influe
nzae,strep. Pyogenes
• Resistent to many beta
lactamases
• Not active on staph
aureus,most pnemococci
and pseudomonas
• Longer acting(t1/2-3 hr)
• s/e- stool changes and
dirrhoea
• CEFTAZIDIME:-
• High againest
pseudomonas
aeruginosa
• Specific indications are-
febrile neutopenic
pts,with hematological
malignancies , burn etc
• Less active on staph
aureus
• Plasma t1/2-1.5-1.8 hr
• s/e-
neutropenia,thrombocyt
openia,rise in plasma
transaminases and blood
urea have been reported.

22. • CEPHALEXIN:-
• Orally effective First generation cephalosporin
• Less active againest penicillinase producing
staphylococci and H.Influenzae
• Plasma protein binding is low,attains high
concentration in bile and is excreted unchanged
in urine
• T1/2 60 min
• Dose- 25-100 mg/kg/day..

23. AMINOGLYCOCIDES
• SYSTEMIC
 Streptomycin
 Gentamycin
 Kanamycin
 Tobramycin
 Amikacin
 Sisomycin
 Netilmycin
 Paromomycin
 Gentamycin - more of vestibuler
toxicity and nephrotoxicity
 Amikacin – more cochlear
toxicity and nephrotoxicity.
• Ionize in solution and not
absorbed orally,
• do not penetrate brain or CSF.
• Excreted unchanged in urine by
glomerular filtration
• All are bactericidal and more
active in alkaline Ph.
• Act by interfering with bacterial
protein synthesis
• Active againest aerobic gram
negetive bacilli and do not
inhibit anaerobes.
• Only partial cross resistance
among them.
• Exhibit ototoxicity and
nephrotoxicity.
• * E coli has developed
resistance to streptomycin

24. • Avoided in pregnancy-fetal ototoxicity
• Avoid concurrent use of other nephrotoxic
drugs like NSAIDS,amphotericin B
,vancomycin etc
• Caution in pts with kidney damage.

25. QUINOLONES
• NALIDIXIC ACID:-
• Seldom employed
• To preserve efficacy use
should be preserved
• Urinary antiseptic
• Active aginest gram negetive
bacteria- E.Coli, klebsiella,
proteus, enterobacter but not
pseudomonas
• Acts by inhibiting bacterial
DNA gyrase and is
bactericidal.
• Resistance developes rapidly.
• Absorbed orally.
• s/e- gi upsets, rashes.
• May cause seizures in
children, visual disturbances,
vertigo. Hedache and
drowsiness.
• c/I in infants., G6pd def.
• DOSE-0 .5-1gm tds or qid

26. FLOROQUINOLONES
• FIRST GENERATION
 Norfloxacin
 Ofloxacin
 Ciprofloxacin
 Perfloxacin
• SECOND GENERATION
 Levofloxacin
 Morifloxacin
 Lomefloxacin
 Sparfloxacin
 Gemifloxacin
 Prulifloxacin
 Inhibit the enzyme bacterial DNA
gyrase.
• CIPROFLOXACIN:-
• Bactericidal , most potent active
againest broad range of bacteria.
• E.coli highly susceptible
• Good safety record
• Caution needed in children-
cartilage damage in growth
bearing joints
• NSAIDS may enhance CNS
toxicity-seizures are reported.
• Antacids,sucralfate and iron salts
reduce absorption.
• High cure rates in UTI.
• Oral and IV available.

27. EXTENDED SPECTRUM PENICILLINS
• AMINOPENICILLINS-
 Ampicillin
 Becampicillin
 Amoxicillin
• CARBOXYPENICILLINS-
 Carbenecillin
• UREIDOPENICILLINS-
 Piperacillin
 mezlocillin
• AMOXICILLIN:-
• Close congener of
ampicillin, similer to it in
respects except-
 Oral absorption is
better,food does not
interfere with
absorption,incidence of
dirrhoea are lower.
 Dose-25-50mg/kg/day 8-
12 hr orally.

28. • SEVERE OE
COMPLICATED UTI:-
 Fever>39*C,marked
toxicity,persistent
vomiting,dehydration
and renal angle
tenderness
 Children <2m and with
CUTI should be
hospitilized and treated
with parenteral
antibiotics.
 IV therapy witb single
dose of aminoglycoside
is found to be safe and
effecive
• For older pts parentral
therapy for first 2-
3days
Then oral antibiotics if
condition improves.

29. • UNCOMPLICATED UTI:-
 AGE>3m,accepting by
mouth,not toxic may be
given oral antibiotics.
 Emerging resistance of
E.Coli to ampicillin and
cotrimoxazole.
 Norfloxacin and
ciprofloxacin should be
reserved for serious
infections.
• Nalidixic acid and
nitrofurantoin should not
be used in febrile
children in whom renal
parenchymal
involvement cannot be
excluded as they are
excreted in the urine
without achieving
therapeutic levels in
blood.
• Symptomatic treatment
for fever and pain.
• Liberal fluid intake
should be ensured.

30. • SULFONAMIDES:- dependibility in UTI has
decreased.
• COTRIMOXAZOLE:-respnose rate has
decreased but can be employed empirically
in acute UTI without bacteriological data.

31. Indication and duration of
treatment
INDICATION DURATION
UTI< 1 yr of age Till imaging studies done
VUR grade 1 &2 Till 1 yr old, afterthat resatart if
breakthrogh UTI
VUR grade 3 & 4 Till 5 yrs of age. Surgery indicated if
breakthrough febrile UTI, beyond 5 yrs
prophylactic antibiotic continued if
bladder and bowel dysfunction
continued

32. Choice of antibiotic for prophylaxis
Medication Dose mg/kg/day remarks
cotrimoxazole 1-2 of trimethoprim,
usually given as single
bedtime dose.
Avoid in infants<3
months, G6PD def. ensure
fluid intake
nitrofurantoin 1-2 May cause vomiting and
nausea, avoid in < 3
months, G6PD def., renal
insufficiency,bacterial
resistance rare
Cephelexin 10 Drug of choice in 3-6
months of life
Cefadroxil
Cefaclor
Cefixime
5
5-10
2
An alternative agent in
early infancy where use of
NFT and cotrimoxazole is

33. FUNGAL UTI
• Most commonly encountered in infants and
children who receive immunosuppressive agents
and broad spectrum antibiotic therapy.
• Incidence is high in ICU’s.
• Commonest organism is Candida albicans.
• Rarely aspergillus or cryptococcus
• Presence of pseudohyphae in urine.
• Oral fluconazole in candida cystitis.
• IV amphoterecin-B(.6-.7 mg/kg) or
fluconazole(5-10mg/kg for 2-4 weeks is
neccesary.

34. • AMPHOTERECIN-B:-
 Active gainest wide range of
fungi and yeasts.
 Administered I.V
 Penetration in CSF poor.
 Urinary concentration of
active drug is low.
 Toxicity is high
 In long term may cause
nephrotoxicity
 Bone marrow depression
 Uses-gold standard of
antifungal therapy
 febrile neutropenia
 Leishmaniasis
 Caution with
aminoglycosides,vancomycin
• FLUCONAZOLE:-
 Excreted unchanged in urine
 Dose reduction needed in
renal impairments.
 Fewer side effects.-
nausea,vomiting,rashes,and
headache.
 Orally or I.v.
 No nephrotoxicity.

35. GENERAL MEASURES
• Increase fluid intake.
• Regular bowel habits with avoidance of
constipation and complete bladder emptying.
• Wiping action in girls –anterior to posterior
• Child should not delay emptying the bladder.

36. RESPONSE TO TREATMENT
• With appropriate treatment urine becomes
sterile after 24 hrs. within 2-3 days symptoms
disappear.
Failure to respond therapy suggests:-
Non sensitivity of pahogens
Presence of complicating factors
Noncompliance
If no response after 2 days of therapy another
urine specimen shpuld be cultured and USG
performed to exclude complicating factors.
Short term treatment for 1-3 days is not
reccomended in children.

37. ISPN LATEST GUIDELINES
• The importance of urine culture on a correctly collected specimen is
reemphasized. The diagnosis of urinary tract infection (UTI) must be based
on a positive urine culture
• Patients with UTI should be evaluated for the presence of complications,
underlying anomalies or voiding dysfunction.
• Detailed investigations are done in infants. In older children, micturating
cystourethrography is done in those who show abnormalities on
ultrasonography and DMSA scintigraphy.
• Patients with recurrent UTI and/or vesicoureteric reflux should be
evaluated for bowel bladder dysfunction.
• Patients with grades I and II reflux should receive antibiotic prophylaxis till
they are 1 year old. Those with higher grades of reflux are given
prophylaxis till 5 years of age, or longer in case of bowel bladder
dysfunction or breakthrough UTI.

38. AAP GUIDELINES
• Specific recommendations in the new Clinical
Practice Guideline include the following:
• Diagnosis of UTI is made from an appropriately
collected urine specimen based on the presence of
pyuria as well as 50,000 colonies per mL or more
of a single uropathogenic organism.
• To facilitate prompt diagnosis and treatment of
recurrent UTIs, close clinical follow-up monitoring
should be maintained after 7 to 14 days of
antimicrobial therapy.

39. • To diagnose anatomic abnormalities, ultrasonography
of the kidneys and bladder should be performed.
• Because evidence from the most recent 6 studies does
not support the use of antimicrobial prophylaxis to
prevent febrile recurrent UTI in infants without VUR
or with grade 1 to 4 VUR, VCUG is not recommended
routinely after the first UTI.
• However, VCUG is indicated if renal and bladder
ultrasonography results show hydronephrosis,
scarring, or other evidence of high-grade VUR or
obstructive uropathy, as well as in other atypical or
complex clinical circumstances.
• Infants and children who have recurrence of a febrile
UTI should also undergo VCUG.

40. KEY MESSAGE
• Urinary tract infections (UTI) are common in infants and
children.
• Any child with unexplained fever should be evaluated for UTI by
urine microscopy and culture.
• Prompt treatment of UTI is necessary to prevent renal injury.
• UTI and associated renal injury are more common if
vesicoureteric reflux is also present.
• All children with UTI should undergo an ultrasound examination
to screen for significant abnormality of the urinary tract.
• Infants are at increased risk of urinary infections and its
complications, and should undergo detailed evaluation.
• Attention to regular voiding and bowel habits are important
measures in preventing recurrent UTI.

41. THANK YOU

42. PATHOGENESIS
• In neonates renal parenchymal infection is due to
hematogenous spread.
• Acute bacterial pyelonephritis may cause or follow
septicemia.
• At all other ages bacteria reach urethra and
bladder by ascending route and ureters and kidney
by VUR.
• Bacteria causing UTI generally arise from bowel
• Bacteria under prepuce in boys reach bladder by
ascending route which explains circumcised boys
have fewer UTI.

43. HOST DEFENCE MECHANISMS
• Very rapid multplication
of bacteria normal
voiding cannot
eliminate all bacteria
• Some are destroyed by
intrinsic defense of the
bladder epithelial cells
• Other defense
mechanisms secretory
IgA in in urine and
blood group antigens in
secretions impede
bacterial adhesion
• Breastfeeding
protective in first 6
months of life
• Human milk provides
adhesive factors in
urine and stablizes
intestinal flora with less
pathogenic
enteropahogens.

44. BACTERIAL VIRULENCE
• Bacterial adhesion by
pili bind to cell surface
by recognizing a
glycosphingolipid
recepter. Which is
critical in the genesis
of pyelonephritis.
• Leads to activation of
cytokines which
produces adhesion
molecules and
chemotaxix of
leukocytes.
VIRULENCE FACTORS-
O antigen of E.Coli
induces inflammation
and fever and capsular
K antigen for resistance to
phagocytosis and the
bactericidal effect of
serum.
Bacteria produce hemolysin
and damages the
uroepithelium and
aerobactin for scavenging
iron from urine needed
in metabolism.

45. • BIOFILM:- once bacterial adhesion occurs
forms a biofilm on epithelial surface.
• Such films have been shown to form on
uroepithelial surface, polymer surfaces of
indwelling catheters and fibre of infant diapers.
• Virulent bacteria quickly form biofilm and
whereas bacteria on the surface are killed by
antibiotics, those in deeper layers resist
treatment.

46. Case scenario 3
• A 5-year-old boy presents with complaints
that “it hurts when I pee.” He has no other
symptoms. On examination, he is afebrile and
noncircumcised.

47. FIRST UTI
AGE < 1 yr AGE 1-5 yr AGE >5 yr
USG
MCU
DMSA
USG
DMSA
MCU IF USG OR
DMSA abnormal
USG
IF ABNORMAL
DMSA AND MCU
RECURRENT UTI in any age group
USG
MCU
DMSA

48. PREDISPOSING FACTORS
• Obstructive uropathy
• Stones in UT
• Incomplete emptying of
bladder with residual
urine
• Constipation
• Thread worm
infestation.
• Noncircumsised infants-
10 times > common
• Broad spectrum
antibiotics for other
infections may abolish
the normal bacterial
flora of perineum
predispose to UTI.
• Short female urethra.
• Babies born to mothers
with bacteuria

49. Case scenario 2
• 14 month old female
• chief complaint of fever, vomiting, and loose stools.
• 5-6 episodes of emesis on the first day of illness.
Stools were liquid on the first and second days of
illness.
• She was seen at an emergency room 2 days ago,
where the impression was gastroenteritis was
made and treatment given.
• No labs or x-rays were done in the emergency
department.

50. • She returns to the emergency now because of
persistent fever. Vomiting and diarrhea have
resolved, but she is breast-feeding less well
than usual.
• Her mother notes that her urine seems
"strong" and that she is not as playful as usual.
She has had no known ill contacts.
• She has no cough, URI symptoms, or rash
• Past history is unremarkable and she is on no
medications.

51. VARIOUS IMAGING MODALITIES ,
INDICATION AND TIMINGS
Imaging modality indication timing
DMSA(
dimercaptosuccinicacid)
scanning
Most sensitive test for
upper urinary tract
involvement detects renal
parenchymal infection and
cortical scarring.
2-3 months after successful
treatment
ultrasound Information on kidney
size,location,hydronephrosis,
urinary bladder anomalies
and post void residual
urine.
Soon after diagnosis of UTI.
MCU Information on posturethral
valve, VUR, urethral anomaly
2-3 weeks later prophylactic
anibiotic given orally for 3
days with MCU on 2nd day
Diuretic renography
DTPA/MAG3
Quantitaive assessment of
renal function and drainage
of dilated collecting system.

52. ROLE OF IMAGING STUDIES
To identify children at high risk of renal
damage especially < 1 yr of age
To identify children with VUR or obstructive
uropathy
To identify upper urinary tract involvement.

53. HOW TO PLAN INVESTIGATIONS.
Diagnosis of UTI is based on routine and
microscopic urine analysis(provisional) and
positive culture of a properly collected
specimen(confirmatory ).
COLLECTION OF SAMPLE:-
 most important step.
Inspite of busy hospital practice, we should
spend time in explaining the parents, how to
collect sample and preserve.

54. • Urine culture  gold standard test
• Rapid dipstick test which detects leukocyte
esterase and nitrite, is useful in screening
for UTI.
• Some studies have also recommended that
in a suspected case of UTI 3 samples for urine
culture must be send for 3 consecutive days.

55. • A clean catch mid stream specimen is ideal
after cleaning the genitalia with soap and
water in toilet trained children.
• In neonates suprapubic catheterisation or
transurethral bladder catheterisation are safe
and easy to perform.
• Collections from urobags are not
recommended.
• If delay is anticipitated in analysis of sample,
it should be refrigerated at 4*C for 12-24 hrs.

56. NORFLOXACIN:-
Less potent than
ciprofloxacin
Given for 8-12 weeks in
chronic UTI.
Unchanged drug and
metabolites excreted in
urine.
• OFLOXACIN:-
• Less effective than
ciprofloxacin againest
gram negetive bacteria
but equally efective for
gram positive ones.
• Alternative drug for
non specific uretheritis.

57. POINTS TO REMEMBER
UTI are common in infants and toddlers,but
underdiagnosed since clinical features are non-
specific.
Most UTI are caused by E.Coli,derived from
periurethral fecal flora.
Pseudomonas and proteus are common in
presence of obstruction and instrumentation.
Fever,toxicity,leucocytosis indicate renal
parenchymal disease.
Report of a few pus cells in an asymptomatic
child is insufficient to start antibiotics.

58. Neonates and young infants must be treated as
inpatients with IV antibiotics for 10-14 days.
Quinolones are avoided as initial therapy.
In < 2 yrs congenital anomalies and VUR are
common and need to be excluded.
An expert USG must be performed in each case.
Fungal balls may occasionally cause obstruction.