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The Addition of Ceftriaxone to Oral Therapy Does Not Improve Outcome in Febrile Children With Urinary Tract Infections
P. Chris Baker, MD;
Douglas S. Nelson, MD;
Jeff E. Schunk, MD
Arch Pediatr Adolesc Med. 2001;155:135-139.
Objective To determine whether the addition of a single dose of ceftriaxone sodium
to a 10-day course of trimethoprim and sulfamethoxazole hastens urine sterilization
or resolution of clinical symptoms in febrile children with urinary tract
infections.
Design Prospective, single-blind, randomized study.
Setting Tertiary care children's hospital emergency department.
Patients Febrile children aged 6 months to 12 years with a presumptive urinary
tract infection based on history, physical examination, and urinalysis findings.
Interventions A history was taken, a physical examination and urinalysis and culture
were performed, and a white blood cell count and erythrocyte sedimentation
rate were obtained. Children were randomized to receive an intramuscular dose
of ceftriaxone then 10 days of trimethoprim-sulfamethoxazole (IM + PO group)
or oral trimethoprim-sulfamethoxazole alone (PO group). After receiving study
medication, patients were discharged from the hospital to return in 48 hours
for a follow-up evaluation and urine culture. Treatment failure was defined
as the persistence of a positive culture at 48 hours or the need for hospital
admission for intravenous rehydration or antibiotic therapy.
Results Sixty-nine children were enrolled, 34 in the IM + PO group and 35 in
the PO group. The 2 groups were similar at the initial visit with respect
to age, sex, clinical degrees of illness, white blood cell count, and erythrocyte
sedimentation rate (P>.05). At the 48-hour follow-up
visit, there were no differences between the 2 treatment groups in resolution
of vomiting, fever, general appearance, abdominal tenderness, and hydration
state (P>.05). There were 9 treatment failures, 4
in the IM + PO group and 5 in the PO group (P = .93).
Conclusion The addition of a single dose of intramuscular ceftriaxone to a 10-day
course of oral trimethoprim-sulfamethoxazole for urinary tract infection with
fever resulted in no difference at 48 hours in the urine sterilization rate,
degree of clinical improvement, or subsequent hospital admission rate.
From the Department of Pediatrics, University of Utah School of Medicine,
and the Emergency Department, Primary Children's Medical Center, Salt Lake
City.
Corresponding author and reprints: P. Chris Baker, MD, 101 Marion
Ave, Sausalito, CA 94965 (e-mail: suzannaz{at}pacbell.net).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Diagnosis and Management of Pediatric Urinary Tract Infections
Zorc et al.
Clin. Microbiol. Rev. 2005;18:417-422.
ABSTRACT
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Treatment of acute pyelonephritis in children
Craig and Hodson
BMJ 2004;328:179-180.
FULL TEXT
Adding Ceftriaxone Does Not Benefit Febrile Children with UTIs
JWatch General 2001;2001:4-4.
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