Management of urinary tract infections in children: antimicrobial sensitivity pattern, efficacy and pharmacoeconomics

ABSTRACT

Background: Urinary tract infections are commonly seen in febrile children, high incidence of Vesico Ureteral Reflux (VUR) is frequently seen in paediatric patient which is of concern as it may lead to renal scarring. Despite presence of established clinical guidelines there is disparity amongst physician in the diagnosis and treatment of UTI, some physician prescribes taking into consideration the symptoms, some prescribe on the basis of smell and colour and some rely on urine culture and sensitivity report. There is dearth of studies in many tertiary health care centers regarding antimicrobial use. Authors conducted this study to evaluate antimicrobial sensitivity pattern, efficacy and cost effectiveness of antimicrobials used for UTI in children.Methods: Patients of urinary tract infection <13 years of age were included in the study. Symptoms of patient i.e. pain in abdomen, haematuria, increased frequency of urination and degree of fever were recorded. Efficacy was measured through calculating degree of defervescence per hour. Cost effective model was prepared by calculating cost effective ratio i.e. dividing cost of antimicrobial required to bring down the fever and degree through which fever came down.Results: E. coli was the most common pathogen isolated from urine positive culture (69.07%). Nitrofurantoin has shown highest sensitivity to all uropathogens (72.73%). Cotrimoxazole, ciprofloxacin and nitrofurantoin were found to be most cost effective.Conclusions: In this current study authors found E coli is the most common uropathogen isolated. Ceftriaxone, cefixime, cotrimoxazole and amikacin were found to be most efficacious. Cotrimoxazole, ciprofloxacin and nitrofurantoin were found to be most cost effective.