Bonsu Bema K, Shuler Lori, Sawicki Laura, Dorst Pam, Cohen Daniel M
Division of Emergency Medicine, Department of Pediatrics, Children's Hospital, Columbus, OH 43205, USA.
Acad Emerg Med. 2006 Jan;13(1):76-81. doi: 10.1197/j.aem.2005.07.032. Epub 2005 Dec 19.
Cefdinir, an extended-spectrum cephalosporin administered orally, is approved by the U.S. Federal Drug Administration for treatment of skin and respiratory tract infections. During the last two years at the authors' institution, this agent has been used as an off-label treatment for urinary tract infections in children.
To evaluate antimicrobial susceptibility testing data in children to determine whether there is support for this prescribing practice.
In this retrospective study (2003-2004), the authors compared the susceptibility patterns of urinary pathogens to cefdinir and selected antibiotics in children who were evaluated for urinary tract infections in an urban tertiary academic pediatric emergency department. Pathogens (community acquired vs. opportunistic or nosocomial) were categorized as susceptible, indeterminate, or resistant on the basis of antibiotic susceptibility breakpoints. The frequency of these categorizations for individual drugs was determined.
Seven hundred five isolates were recovered from urine during the study period. Pathogens isolated most frequently were Escherichia coli, Klebsiella spp, and Proteus spp. Of 431 isolates retained in the data set, 412 (95.6%) were susceptible to cefdinir. This rate was comparable or superior to rates observed for other antibiotics: 49.4% for ampicillin, 84.9% for trimethoprim-sulfamethoxazole, 88.4% for cefazolin, 93.3% for nitrofurantoin, 94.2% for ticarcillin-clavulanate potassium, 97.5% for gentamicin, and 97.7% for ceftriaxone. Cefdinir, however, had lower activity (64.7%) against 17 bacterial isolates categorized as opportunistic or nosocomial pathogens.
Cefdinir provides good coverage against common pathogens responsible for urinary tract infections in children and compares favorably with other oral and parenteral antibiotics that are used in the empiric treatment of this infection.
头孢地尼是一种口服的广谱头孢菌素，已获美国联邦药物管理局批准用于治疗皮肤和呼吸道感染。在作者所在机构的过去两年中，该药物一直被用作儿童尿路感染的非标签治疗药物。
评估儿童的抗菌药敏试验数据，以确定这种处方做法是否有依据。
在这项回顾性研究（2003 - 2004年）中，作者比较了城市三级学术儿科急诊科因尿路感染接受评估的儿童尿液中病原体对头孢地尼和选定抗生素的药敏模式。根据抗生素药敏断点，将病原体（社区获得性与机会性或医院获得性）分类为敏感、不确定或耐药。确定了每种药物这些分类的频率。
在研究期间从尿液中分离出705株菌株。最常分离出的病原体是大肠杆菌、克雷伯菌属和变形杆菌属。在数据集中保留的431株菌株中，412株（95.6%）对头孢地尼敏感。该比率与其他抗生素观察到的比率相当或更高：氨苄西林为49.4%，甲氧苄啶 - 磺胺甲恶唑为84.9%，头孢唑林为88.4%，呋喃妥因为93.3%，替卡西林 - 克拉维酸钾为94.2%，庆大霉素为97.5%，头孢曲松为97.7%。然而，头孢地尼对17株被分类为机会性或医院获得性病原体的细菌菌株活性较低（64.7%）。
头孢地尼对引起儿童尿路感染的常见病原体具有良好的覆盖范围，与用于该感染经验性治疗的其他口服和静脉用抗生素相比具有优势。
