ANTIBIOTIC STEWARDSHIP IN CHILDREN WITH URINARY TRACT INFECTIONS: PATTERNS AND PITFALLS

Background: Urinary tract infection was first described by Roger in 1839 and since then considerable clinical experience and research have been done on this entity. UTI is one of the most common infections in pediatrics. Urinary tract infection (UTI) is defined as localization of bacteria in the renal parenchyma, renal pelvis, bladder or the urethra irrespective of the fact whether the child is symptomatic or asymptomatic. It is an infection which affects any part of the urinary system. UTI leads to an inflammatory response in the epithelium of the urinary tract. Urinary tract infection can affect both lower and upper urinary tracts. Objectives: The objective of the study is to determine the antibiotic pattern of urinary isolates, most effective antibiotics for empirical treatment of UTI and evaluate the safety of the drugs given. Methods: In this prospective observational study, we analyzed totally 96 subjects with Urinary tract infections in pediatrics department of Santhiram medical college and general hospital, Nandyal from June 2019 to November 2019. The study based on demographic data and prescription pattern, urine culture report, along with the antimicrobial sensitivity test were evaluated. Results: In this study it was observed that females (56) were more prone to urinary tract infections when compared to males (40). Females and males age of 11 to 12 years were more prone to UTI. Males at age group of 78 yrs and females at age group of 5-6 yrs and 11-12 yrs were more prone to the staphylococcus, males of all ages are equally affected and females of age 9-10 and 11-12years are more prone to E. coli, Males of age 9-10 and females of age 1-2yrs were more prone to klebsiella Pneumoniae. It was observed that the females of age 11-12 years were more affected with cystitis when compared to males. It was also observed that organisms were sensitive to Cephalosporins (cefixime) and resistance to penicillin (Piperacillin, Ampicillin) in a greater number of patients and cefixime and amoxiclav are the drugs used for the cystitis. Of all 96 patients treated for UTI Cephalosporins (cefixime and ceftriaxone) were used in 59%, penicillin (Amoxiclav) was used in 29%, Aminoglycosides (Amikacin) were used in 4% and miscellaneous (Imipenem, Vancomycin, Nitrofurantoin) were used in 8%. Conclusion: In our study, most of the patients were positive for staphylococcus organism followed by E. coli and Klebsiella Pneumonia respectively. Among the culture positive patients those with staphylococcus organism were treated with amoxiclav and cefixime mostly, patients with E. coli were treated with ceftriaxone and patients with klebsiella were treated with Imipenem, Amikacin and ceftriaxone. Cefixime was used mostly for the patients with cystitis. The drugs involved in our study are rational with no drug interactions and other drug related problems.