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Antibiotic prophylaxis to prevent urinary tract infection in infants and children

Antibiotic prophylaxis to prevent urinary tract infection in infants and children
Agents Comments
Age <2 months
Amoxicillin 10 to 15 mg/kg orally once daily

Switch to 1 of the agents below after 2 months of age

For this age group, we use amoxicillin unless the infant has a penicillin allergy; cephalexin is a reasonable alternative

Cephalexin 10 mg/kg orally once daily
Age ≥2 months
Trimethoprim-sulfamethoxazole 2 to 3 mg/kg trimethoprim component orally once daily (maximum 80 mg trimethoprim/dose) Avoid in infants <2 months old (risk of hyperbilirubinemia due to hepatic immaturity)
Nitrofurantoin 1 to 2 mg/kg orally once daily (maximum 100 mg/dose) Avoid in infants <1 month old or children with G6PD deficiency (risk of hemolytic anemia)
Trimethoprim (monotherapy) 1 to 3 mg/kg orally once daily (maximum 100 mg/dose)

Avoid in infants <1 month old

An oral suspension is not commercially available but may be compounded from the tablets

This table describes options for antibiotic prophylaxis for children at risk for UTIs, including selected children with vesicoureteral reflux or recurrent UTI. Dosing is intended for patients with normal kidney function; refer to drug monographs for dose adjustments. For details on patient selection and treatment duration, refer to UpToDate content on vesicoureteral reflux and UTIs in children.
G6PD: glucose-6-phosphage dehydrogenase; UTI: urinary tract infection.
Graphic 148527 Version 1.0

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