0-2 months old

First line:

Ampicillin 50mg/kg/dose IV

≤ 1 week of age: q12h

> 1 week of age: q8h

PLUS

Gentamicin 5mg/kg/dose IV

≤ 30 week of CGA: q48h

> 30-34 week of CGA: q36h

> 35 weeks of CGA: q24h

Second line:

Cefotaxime 150-200mg/kg/day IV in 3 divided doses (max. 6g/day), MAY ADD

Amikacin 15mg/kg/dose IV daily

≥ 3 months old

First line:

Cephalexin 25-50mg/kg/day PO in 2 divided doses (max. 2g/day) 

OR

Amoxicillin/clavulanate

Amoxycillin component:

Suspension (Formulation 14:1)

Amoxicillin / Clavulanate 80-90mg/kg/day PO in 2 divided doses 

Suspension (Formulation 7:1)

Amoxicillin / Clavulanate 40-45mg/kg/day PO in 2 divided doses 

Second line:

Cefotaxime 50 mg /kg /dose IV q8h (max. 6g/day)

OR

Ceftriaxone 50mg / kg/dose IV q12h (max. 2g/day)

MAY ADD

Amikacin 15mg/kg/dose IV daily

--

Duration: 7 – 10 days

Adjust therapy based on culture result.

Switch to oral therapy when improving and able to tolerate oral therapy.

For Aminoglycoside (Gentamicin):

DOSES AT EXTREMES OF BODY-WEIGHT

With intravenous use to avoid excessive dosage in obese patients, use ideal weight for height to calculate parenteral dose and monitor serum concentration closely.

Amoxicillin/clavulanate 

Amoxycillin component:

Suspension (Formulation 14:1)

Amoxicillin / Clavulanate 80-90mg/kg/day PO in 2 divided doses 

Suspension (Formulation 7:1)

Amoxicillin / Clavulanate 40-45mg/kg/day PO in 2 divided doses

OR

Cefuroxime   30 mg /kg/day PO in 2 divided doses (max. 500mg/day)

OR

Trimethoprim/sulfamethoxazole 8-10mg/kg/day (TMP dose) PO in 2 divided doses

Nitrofurantoin 2mg/kg/dose PO q12h or 1mg/kg/dose q6h (immediate release tablets)

(max. 100mg/dose)

Duration: 3-5 days

Trimethoprim 1-2mg/kg PO at night (max. 100mg ON)

OR

Trimethoprim/sulfamethoxazole 2mg/kg (TMP dose) PO at night

OR

Nitrofurantoin 1-2mg/kg PO at night (max. 100mg ON)

Cephalexin 12.5mg/kg PO at night (max.125mg/dose) 

Antibiotic prophylaxis should not be routinely recommended in children with first-time UTI.

Prophylactic antibiotics should be given for 3 days with MCUG (micturatingcystourethogram) taking place on the second day.

Children with Grade I-IV vesicoureteral reflux (VUR) may experience a decrease in recurrent UTI by 50% following first or second febrile or symptomatic UTI with increased detection of resistant organisms following antibiotic prophylaxis.