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Clinical bottom line
Oral antibiotics are well absorbed in infants younger than 3 months (Grade B).
First-line oral antibiotic therapy is supported by several international consensus statements for well-looking infants older than 2 months (Grade B).
A period of observation, with measurement of procalcitonin, may be a safe strategy to identify young infants with urinary tract infection suitable for outpatient management (Grade C).
A 10-week-old boy was brought to Accident and Emergency due to poor feeding. On assessment, he was happy and alert and remained asymptomatic after a period of observation, breast feeding well. However, a routine clean-catch urine sample was obtained and revealed white cells on microscopy, confirmed on repeat testing. He was therefore cannulated and started on parenteral antibiotics as per national and trust guidelines. However, could the patient and family experience be improved by commencing oral antibiotics first line?
Structured clinical question
In asymptomatic infants aged 60–90 days (patient), are oral antibiotics (intervention) compared with parenteral antibiotics (comparison) equivalent (outcome) for initial treatment of urinary tract infection (UTI)?
A literature search was conducted using Medline, EMBASE and PubMed databases. Search terms were “urinary tract infection” AND “oral antibiotics” AND (“children” or “infant”). Papers were then reviewed for studies including infants under the age of 3 months. A total of 269 articles were found, of which 4 were included for detailed review. Papers were excluded from the main evidence summary (Table 1) if they did not use oral antibiotics as initial therapy.
Asymptomatic UTI is a commonly encountered problem in young infants and causes uncertainty among clinicians.1 Urine collection for infants under 3 months is recommended for non-specific symptoms such as lethargy and poor feeding by national guidelines,2 increasing the diagnosis of incidental UTI. Prevention of renal scarring is a key target of UTI management, with its development increasing the …
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.