Evidence behind the WHO guidelines: Hospital care for children: What is the appropriate empiric antibiotic therapy in uncomplicated urinary tract infections in children in developing countries?

The World Health Organization has produced guidelines for the management of common illnesses in hospitals with limited resources. This series reviews the scientific evidence behind WHO's recommendations. The WHO guidelines, and more reviews are available at: http://www.ichrc.org This review addresses the question: What is the appropriate empiric antibiotic therapy in uncomplicated urinary tract infections in children in developing countries? The WHO Pocketbook of Hospital Care for Children recommends for antibiotic therapy Give oral cotrimoxazole (4 mg trimethoprim/20 mg sulfamethoxazole per kg every 12 h) for 5 days. Alternatives include ampicillin, amoxicillin and cephalexin, depending on local sensitivity patterns of Escherichia coli and other Gram-negative bacilli that cause UTI, and on antibiotic availability (see page 325 for details of dosage regimens). If there is a poor response to the first-line antibiotic or the child's condition deteriorates, give gentamicin (7.5 mg kg(-1) IM once daily) plus ampicillin (50 mg kg(-1) INl/IV every 6h) or a parenteral cephalosporin (see pages 330-331). Consider complications such as pyelonephritis (tenderness in the costo-vertebral angle and high fever) or septicaemia. Treat young infants aged <2 months with gentamicin (7.5 mg kg(-1) IM once daily) until the fever has subsided; then review, look for signs of systemic infection, and if absent, continue with oral treatment, as described above. (Pocketbook chapter 6.8, page 164).