Appropriateness of Dx, Antibiotic Use in Pediatric Uncomplicated UTIs

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Appropriate diagnosis was defined as confirmed UTI which included: pyuria, a positive urine culture, and lower urinary tract symptoms.

This article is written live from ID Week 2017 Annual Meeting in San Diego, CA. MPR will be reporting news on the latest findings from leading experts in infectious diseases. Check back for more news from IDWeek 2017.

SAN DIEGO—According to results of a retrospective review presented at IDWeek 2017, the majority of uncomplicated urinary tract infections (UTI) seen in the pediatric ambulatory care setting are inappropriately diagnosed and treated, indicating education in this field is essential.

Electronic records of 178 patients aged 2 to 18 years that had been diagnosed and treated for an uncomplicated UTI were reviewed. The study authors evaluated the appropriateness of both the diagnosis of the uncomplicated UTI as well as the treatment regimen initiated.

Lead study author Ban Al-Sayyed, MD, of the University of Illinois College of Medicine at Peoria, in Peoria, IL, explained, “Appropriate diagnosis was defined as confirmed UTI which included: pyuria (>5 WBC per HPF or positive for LE), a positive urine culture (≥50,000 colony units/mL of a single uropathogen for a catheterized sample or ≥100,000 colony units/mL for a clean catch urine sample), and lower urinary tract symptoms.”

Additionally, treatment was deemed appropriate if a patient was treated with a first-line antibiotic based on the susceptible isolate, the appropriate dose of antibiotic was prescribed, and the duration of therapy was 5 to 10 days. The study authors noted that first-line antibiotics included trimethoprim sulfamethoxazole (TMP-SMX), amoxicillin-clavulanate, nitrofurantoin, and cephalexin, while they considered 3rd generation cephalosporins and quinolones to be broad-spectrum antibiotics. Additionally, treatment costs were estimated in both groups.

Dr. Al-Sayyed reported, “Of all patients, 70.2% were inappropriately diagnosed (n=125) with polymicrobial growth in their urine cultures (56.8%, n=71).” Of these patients, 52.8% were prescribed TMP-SMX (n=66) and 21.6% were prescribed cephalexin (n=27). Analysis found that of the 29.8% of patients in the study that were actually appropriately diagnosed (n=53), 26.4% were treated inappropriately (n=14), either with broad-spectrum antibiotics (n=8) or with inadequate doses (n=6). 

Findings of the study also showed that 15% of all patients were prescribed broad-spectrum antibiotics (n=26). Dr. Al-Sayyed added, “The estimated cost of antibiotic treatment for inappropriately diagnosed group (n=125) was $10,755.87.”

Inappropriate diagnosis and treatment of uncomplicated UTIs is very common in pediatric patients seen in the outpatient setting. In order to provide optimal care for these patients and reduce treatment costs, the study authors recommend developing antibiograms as well as increasing education in this field. 

For continuous infectious disease news coverage from the IDWeek 2017, check back to MPR’s IDWeek page for the latest updates.


Al-Sayyed B, Le J, Al-Tabbaa MM, et al. Uncomplicated Urinary Tract Infection (UTI) in Ambulatory Primary Care Pediatrics. Are We Using Antibiotics Appropriately? Poster presented at IDWeek; October 4–8, 2017; San Diego, CA.