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Acute cystitis in children older than two years and adolescents

INITIAL TREATMENT — Initial treatment of the child with acute cystitis depends upon the patient's age, the etiology of the disease, and the antimicrobial resistance patterns in the community.

Bacterial cystitis

Select oral antibiotic regimens used for the treatment of acute cystitis in older children and adolescents are listed in the table

* Many strains of E. coli are resistant to amoxicillin.
• E. coli also may be resistant to cephalexin.

We recommend that empiric therapy for uncomplicated acute bacterial cystitis in children between 2 and 13 years of age provide coverage for E. coli; we suggest a second- or third-generation cephalosporin for these patients

We recommend that empirical therapy for uncomplicated acute bacterial cystitis in adolescents (≥age 13 years) provide coverage for common uropathogens such as E. coli and other gram-negative organisms. S. saprophyticus also should be considered. We suggest trimethoprim-sulfamethoxazole (TMP-SMX) or a cephalosporin for these patients . The most appropriate first-line therapy is suggested by local susceptibility patterns.

First-generation cephalosporins, and TMP-SMX should be used with caution in patients in whom E. coli is suspected, since increasing rates of resistance to these antibiotics have been reported in some communities

Nitrofurantoin should not be used in male adolescents in whom occult prostatitis is suspected since it does not achieve reliable tissue concentrations.

Fluoroquinolones are useful in the treatment of S. saprophyticus, a urinary pathogen usually isolated in young, sexually active females. However, the safety of quinolones in children is still under study, and fluoroquinolones are not recommended for uncomplicated UTI .

Parenteral therapy occasionally is indicated for the treatment of complicated cystitis caused by multiply-resistant uropathogens, or for patients who are allergic or intolerant to available and appropriate oral agents. Patients initially given parenteral therapy can be switched to oral agents after clinical improvement.

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