ESPN 51th Annual Meeting

ESPN 2018

The efficacy of nitrofurantoin for children with acute cystitis caused by extended spectrum β-lactamase producing Escherichia coli

1- Department of Pediatric Nephrology, Firat University School of Medicine, Elazig / Turkey

 Acute cystitis in children caused by extended spectrum β-lactamase (ESBL) producing Escherichia coli (E. coli) is increasing on the rise. It is reported that oral antibiotics can be used in ESBL-producing E. coli. The aim of this study was to investigate the clinical and microbiological efficacy of nitrofurantoin treatment in children with lower urinary tract infection (UTI) due to ESBL-producing E. coli.  

Material and methods:

 We prospectively studied 50 children with lower UTI due to ESBL-producing E. coli. Demographic data, clinical condition, laboratory values, treatment regimens and complications of the patients were recorded. Urine samples were obtained by transurethral catheterization or clean-catch; urine bags were not used for specimen collection for culture. Patients with UTI caused by ESBL producing E. coli and found to be susceptible to nitrofurantoin were given oral nitrofurantoin at 5-7 mg / kg / day in 4 divided doses for 10 days. Patients were re-evaluated 3-4 days after end of the treatment. Technetium 99m Dimercaptosuccinic acid (Tc-99m DMSA) scintigraphy was performed 1-3 months after end of the treatment.  


  A total of 50 pediatric patients (48 females, 2 males) were enrolled into study. The mean age was 7.5 ± 3.96 years (range 1-17 years). The duration of nitrofurantoin treatment was 10 days. Bacteriological response was observed in 49 of 50 patients (%98). No any patient had symptoms following treatment. No significant side effect was observed in any of the patients. All patients had normal serum creatine values. Scintigraphic study, which performed in all patients 4-6 weeks after completion of treatment, demonstrated the scarring in 48 of 50 patients (%96). Of the patients with synticgraphic abnormalities, one had scarring in the right kidney without loss of renal functions. The other patient had Grade II vesicoureteral reflux with 9% reduction in function of the right kidney.    


 Our study suggests that oral nitrofurantoin treatment could be a good alternative for lower UTI caused by ESBL producing E. coli in pediatric patients.