Cephalexin for Pediatric UTI

Spoon Feed
A push to use cephalexin vs cefixime for uncomplicated pediatric UTI was successful at this medical center.  Whether this is an improvement in prescribing depends upon local E. coli resistance.

Why does this matter?
Use of a narrow spectrum antibiotic rather than broad spectrum is important in curtailing antibiotic resistance.  At many sites, E. coli is sensitive to cephalexin, though it is usually used primarily for gram-positive infections and has limited gram-negative activity.  However, you need to know your local antibiogram.

Cepha-what?
This was a local QA project to encourage use of narrower spectrum cephalexin (first generation cephalosporin), as opposed to cefixime (3rd generation) for uncomplicated pediatric UTI.  They found an increase in cephalexin use and decrease in cefixime use, which was the primary outcome.  At this center, this was an improvement, as the majority of E. coli isolates were sensitive to cephalexin, as they are at many centers.  However, to know if this would be a wise choice, you would need to know the resistance patterns in your area, as they can vary widely.  I covered this article to put another pediatric UTI treatment option in the front of your mind.  Check your local resistance and use it if you can.  It is cheap, well tolerated, and is good antibiotic stewardship to use a narrower spectrum agent when appropriate.  Unfortunately, my medical center does not test E. coli against any first-generation agents, so I don't know if I can use cephalexin for this or not.  Keep in mind, children with genitourinary anomalies or recurrent UTI were excluded.  This was only new onset uncomplicated UTI.

Another Spoonful
The AAP recommends cephalexin first line for uncomplicated UTI if local resistance patterns show sensitivity to it as does the CDC.

Source
Improving Antibiotic Prescribing for Children With Urinary Tract Infection in Emergency and Urgent Care Settings. Pediatr Emerg Care. 2018 Jan 2. doi: 10.1097/PEC.0000000000001342. [Epub ahead of print]

Peer reviewed by Thomas Davis, MD.

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