Letters to the Editor

Indian Pediatrics 2002; 39:793

Consensus Statement on the Management of UTI

The consensus statement on the management of UTI(1) does a good job of laying down guidelines for the clinician. However certain recommendations need further clarification. The use of once a day aminoglycosides needs to be emphasized adequately. Extensive data is now available to show that once a day administration of aminoglycosides is more convenient [since ideally it should not be pushed but given by a slow infusion]. More importantly, toxicity of aminoglycosides is clearly related to the duration for which serum levels remain high and adverse effects are clearly lower with once a day aminoglycosides. When using a group which has immense potential for nephrotoxicity in a renal indication such as a UTI, every effort needs to be made to minimize the iatrogenic nephrotoxicity that can be caused. Further, serum aminoglycoside level monitoring is usually unnecessary when once a day dosing is used (2). Hence the recommendation should be to use aminoglycosides with extreme caution in such indications and only once daily by slow i.v. infusion.

Secondly, in the area of antimicrobials used for prophylaxis, cefadroxil can easily replace cephalexin with an easy twice a day dosing and dosing unrelated to meals with no loss of efficacy. We find hardly any mention about cefadroxil in the Western literature since the molecule is prohibitively expensive in the west as compared to cephalexin. However since cefadroxil is affordable in our country, there is no reason to use cephalexin in any indication and needs to be replaced by cefadroxil everywhere.

Thirdly, if the orignal organism causing the UTI is resistant to the common list of prophylactic agents such as cotrimoxazole, nitrofurantoin or cephalexin as is commonly the case, can these medications still be used for prophylaxis or should we use antibiotics as dictated by the original sensitivity report and include medications such as norfloxacin, ciprofloxacin and cefixime in our prophylactic regimens? Should we continue for prophylaxis the antibiotic used to treat the original UTI?

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References

1. Bagga A, Babu K, Kanitkar M, Srivastava RN. Consensus statement on the management of Urinary Tract Infections. Indian Pediatr 2001; 38: 1106-1115.

2. Archer Gl, Polk RE. Treatment and prophylaxis of bacterial infections. In: Harrison’s Principles of Internal Medicine, 15th edn. Eds. Braunwald E, Hauser SL, Fauci AS, Longo DL, Casper DL, Jameson LJ, New York, McGraw Hill, 2001, pp 878-879.