Use of Cranberry Products for UTI Prevention in Pediatric Patients

A common infection in the pediatric population is a Urinary Tract Infection (UTI). A UTI can occur due to obstruction of urine flow or urinary stasis. The pathogen that causes most UTIs is called Escherichia coli in adults. In children, however, the most common cause of UTIs is Pseudomonas. Low-dose antibiotics were given for prophylaxis in the past to children who showed obstructive disease or recurrent UTIs. Now, it is realized that this leads to antibiotic resistance and other interventions need to be explored.

Healthcare professionals initially believed that cranberry would be an effective prevention of UTIs because it would cause the urinary tract system to be more acidic, but it is not known for sure that the urine pH changes. Now, cranberry is thought to stop the attachment of bacteria to the uroepithelial cells and also that it inhibits the formation of biofilm bacteria. Cranberry use has been studied in the prevention of recurrent UTIs in women, so now researchers are studying the possible benefits in children.

Eight clinical trials were reviewed and their results showed that cranberry is a safe and effective option that could prevent recurrent UTIs in pediatric  patients. This is especially true for otherwise healthy patients. A dose of 2-5 mL/kg/day proved to have the most benefit in the pediatric population. Should clinicians promote the use of cranberry supplements  for the prophylaxis of UTIs  to parents with children or should they only address that if the child develops a UTI first?

Durham SH, Stamm PL, Eiland LS. Cranberry Products for the Prophylaxis of Urinary Tract Infections in Pediatric Patients. Ann Pharmacother. 2015: 49(12); 1349-1356. http://aop.sagepub.com/content/49/12/1349.full.pdf

Antibiotic Resistance in Infants 2 months old

Researchers conducted a study about antibiotic resistance in infants under three months year old, specifically those experiencing uropathogens.  Within the study, previously healthy infants with urinary tract infections were observed.  Because there are limited data on antibiotic resistance of uropathogens in young infants, this study was of interest to the researchers.  The infants’ susceptibility to antibiotics was recorded, and this was conducted utilizing a urine sample or supra-pubic aspiration.

There has been a problem in which sepsis in neonates and UTIs in children are occurring due to antimicrobial resistance in Gram-negative bacteria (GNBs).  Many of the infants observed in this study who had UTIs were caused by GNBs that were resistant to several antibiotic classes.  The resistance rates observed were 73.7% to ampicillin, 22.1% cefazoline, 21.8% ampicillin/clavulanate, 7.8% cefuroxime, and 7% gentamicin.

The current standard treatment for infants with UTIs who are less than two months old is by IV.  It is an inpatient therapy, but there is evidence that there is equal efficacy in oral therapy.  Regardless of route of administration, gram-negative uropathogens express resistance even at two months of age.  This challenges the empirical therapy and compromises oral treatment options.  For this, antibiotic resistance and therapy choices should be monitored in infants to determine the correct antibiotic for them.

It was surprising to me how infants can experience antibiotic resistance prior to any exposure in the past.  Resistance is troublesome in any patient, but the idea of resistance in infants creates a different struggle.  What, as pharmacists can we do to assist in treating infants with antibiotic resistance?  When should the baby be screened for resistance?  Should it wait until the diagnosis and when the infant starts treatment?

Segal Z, Cohen MJ, Engelhard D, et al. Infants under two months of age with urinary tract infection are showing increasing resistance to empirical and oral antibiotics.  Acta Paediatricia. 2015:1-5.