[Antibiotic treatment of urinary tract infections in hospitalized children].

From 1980 to 1991 237 patients (aged 1 week to 15 years) with moderate to severe urinary tract infection had been treated at the Department of Pediatrics University of Berne, Switzerland. Bacterial etiology, antimicrobial in vitro susceptibility tests, and drug management were retrospectively analyzed. 266 bacterial pathogens were isolated from these patients. Escherichia coli was the most frequent etiologic agent (203), followed by Enterococcus (21), Klebsiella (20), Proteus (12), Pseudomonas (6), Enterobacter (2) and Serratia (2). The overall in vitro susceptibility of these isolates was 61% for aminopenicillins, 80% for co-amoxiclav, 83% for co-trimoxazole and 92% for aminoglycosides. Aminoglycosides were ineffective in vitro only against enterococci. However, since all enterococcal strains were always sensitive to aminopenicillins, none of the pathogens was concomitantly resistant to both aminoglycosides and aminopenicillins. Parenteral therapy had been given initially in 141 patients (59%); aminopenicillin and aminoglycoside in 105, and aminopenicillin alone in 36 cases (cefuroxime instead of aminopenicillin in some patients with suspected allergy to penicillin). 96 patients (41%) were initially treated with oral antibiotics (cotrimoxazole, aminopenicillin or co-amoxiclav). The initial antimicrobial regimen had to be modified in 31 cases (13%). In children with moderate to severe urinary tract infection prompt sterilization of urine and kidneys will prevent or suppress renal tissue lesions. The in vitro susceptibility results observed in the pathogens isolated in the patients prompt us to suggest that the above mentioned goal can only be achieved by an initial regimen consisting of an aminopenicillin and an aminoglycoside compound administered parenterally.