Urinary tract infection in children

250-1,000 mg every 6 hours, or 500 mg every 12 hours (maximum 4 g/day) x 3-7 days for cystitis over 2 years; 7-14 days under 2 years or in pyelonephritis

25-50 mg/kg/day [child max 2000 mg]

(Mild to moderate infection: 25-50 mg/kg/day divided every 6 or 12 hours, maximum 2,000 mg/day. Severe infection (the formulary gives bone and joint infection as its example): 75-100 mg/kg/day divided every 6 to 8 hours, maximum 4,000 mg/day.)

Alternatives. Cephalexin is the everyday oral choice: cheap, stocked everywhere in Egypt as a suspension, and active against the organisms that cause most childhood urinary infection. Co-amoxiclav is the alternative where a broader cover is wanted; nitrofurantoin treats the bladder only and must not be used when the kidney is involved; ceftriaxone is the injection for the baby or the child too unwell for anything oral.

Egyptian National Drug Formulary - Antimicrobial 2023 (cephalexin monograph)

A first-generation cephalosporin. The cited disease article says first-generation cephalosporins such as cephalexin cover the usual urinary organisms well, are well tolerated, are widely available and are cheap, with the one drawback that they must be given at least three times a day. The formulary's own indication list for this drug names genitourinary tract infection caused by E. coli, Proteus mirabilis and Klebsiella pneumoniae - the three organisms that cause most childhood urinary infection - so the drug and the indication come from the same monograph as the dose.

Simple cystitis 500 mg twice daily; complicated infection or pyelonephritis 875 mg twice daily x 3-7 days for cystitis over 2 years; 10-14 days for pyelonephritis

20-40 mg/kg/day [child max 1500 mg]

(THE DOSE DEPENDS ON WHICH SUSPENSION IS IN YOUR HAND, and the milligrams are of the amoxicillin half only. The grid above is the 4:1 suspension (125/31.25 or 250/62.5): 20-40 mg amoxicillin/kg/day in three divided doses, maximum 1,500 mg/day. For the 7:1 suspensions (200/28.5, 400/57) the formulary gives 25-45 mg amoxicillin/kg/day in two divided doses, maximum 1,750 mg/day. The 125 mg/5 mL suspension is the only preparation the formulary allows in a neonate or an infant under 12 weeks.)

Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin and clavulanate monograph)

The cited disease article names amoxicillin-clavulanate, alongside second and third generation cephalosporins, as a preferred option for an acute uncomplicated urinary infection in a child. The formulary lists urinary tract infection among this drug's oral indications and gives the paediatric milligram-per-kilogram rule quoted below.

1-2 g once daily by intramuscular or intravenous injection (maximum 2 g daily for a urinary infection) - until the child can keep an oral antibiotic down, then switch

50-75 mg/kg/dose [child max 1000 mg]

(Infants, children and adolescents, mild to moderate infection: 50-75 mg/kg as a single daily dose by IM or IV, maximum 1,000 mg a day. Premature and term neonates: 50 mg/kg every 24 hours. The formulary caps most infections other than endocarditis and meningitis at 2 g daily.)

WATCH group - carries resistance cost. Egyptian EML 2025.

Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph)

The injection for the child who cannot be treated by mouth. The cited disease article says the parenteral route is advised for any infant of 2 months or under, and for any child who looks toxic, who has bacteraemia or sepsis, whose circulation is unstable, who is immunocompromised, who cannot keep an oral medicine down, or who has not responded to one. The formulary names complicated urinary tract infection including pyelonephritis among this drug's indications and gives the paediatric rule below. Give it as part of getting the child to hospital, not instead of it.

50-100 mg four times daily x 7 days, or at least 3 days after the urine is sterile

5-7 mg/kg/day

(Children of 1 month and over: 5-7 mg/kg/day in four divided doses for 7 days, or for at least 3 days after the urine becomes sterile. For long-term suppression the formulary gives 1 mg/kg/day as a single dose or in two divided doses. For prevention of recurrence: 1-2 mg/kg/day, single bedtime dose or divided twice daily, maximum 100 mg/day.)

Egyptian National Drug Formulary - Antimicrobial 2023 (nitrofurantoin monograph)

A urinary antiseptic that concentrates in the bladder urine. The formulary names acute uncomplicated cystitis as its indication and gives a paediatric rule from one month of age. It is kept at second line here for the reason the disease article gives: it does not reach the kidney, so it is the wrong drug the moment the infection is above the bladder - and in a young child that is hard to be sure of.

Urinary tract infection in under 16s: diagnosis and management - NICE Guideline NG224 (NCBI Bookshelf NBK588844) - https://www.ncbi.nlm.nih.gov/books/NBK588844/

The antibiotic choices for a urinary infection are the same drugs a child would get anywhere and are dosed on the uti-uncomplicated card. What is specific to children is who must be referred rather than treated, how the urine has to be collected before it means anything, and which child needs a scan afterwards. No antibiotic row is printed here because neither cached article states a milligram-per-kilogram amount, and a dose carried across from an adult card is a dose nobody checked.