Treatment strategies for urinary tract infections based on fever

Abstract

Abstract Purpose The duration of antimicrobial therapy for febrile urinary tract infections (fUTI) in children have not been established. This study aimed to explore the appropriate duration of the treatment for fUTI in children. Methods We created a protocol to determine the duration of antibiotic administration based on the fever. Transvenous antibiotics were administered for 3 days after the resolution of fever, followed by oral antibiotics for 1 week. Diagnosis of fUTI was based on a fever of 37.5°C or higher and a quantitative culture of catheterized urine showed ≥5 × 104 bacteria. Acute focal bacterial nephritis (AFBN) and pyelonephritis (PN) were diagnosed based on contrast-enhanced computed tomography (eCT) findings. We retrospectively reviewed the treatment outcomes. Results Of the 78 patients treated according to our protocol, 58 were included; 49 with PN (30 men) and nine with AFBN (three men). Blood test results showed that patients with AFBN had significantly higher white blood cell and C-reactive protein levels than those with PN; however, no differences were observed in the urinary findings and causative bacteria. The time to resolution of fever and duration of intravenous antibiotic administration were significantly longer in patients with AFBN than in those with PN. However, the average duration of AFBN treatment was 14.2 days, which was shorter than the previously reported 3-week administration and no recurrence was observed in AFBN patients. Conclusions The protocol created to determine the duration of antimicrobial treatment based on fever is useful. Invasive examinations, such as eCT, are not required.