Lactante con ITU febril: dosis inicial de ceftriaxona IM, ¿sí o no?

En los lactantes con infección urinaria febril, la administración de una primera dosis de ceftriaxona intramuscular en ugencias seguida de una pauta de cefixima oral sigue siendo una práctica relativamente extendida.

Al igual que en estudios anteriores, este artículo publicado recientemente en Pediatrics no encuentra evidencias que apoyen esta práctica, al no encontrar diferencias en cuanto al porcentaje de revisitas en urgencias que hayan precisado ingresos.

Como limitación importante encontramos que la decisión de administrar ceftriaxona IM fue según criterio clínico, pudiendo haber cofactores ,como el estado clínico o los resultado clínicos, que influyan en la evolución de cada grupo.

Emergency Department Revisits After an Initial Parenteral Antibiotic Dose for UTI

BACKGROUND: Although oral antibiotics are recommended for the management of most urinary tract infections (UTIs), the administration of parenteral antibiotics before emergency department (ED) discharge is common. We investigated the relationship between the administration of a single dose of parenteral antibiotics before ED discharge and revisits requiring admission among children with UTIs.

METHODS: A retrospective analysis of administrative data from 36 pediatric hospitals was performed. Patients aged 29 days to 2 years who were evaluated in the ED with a UTI between 2010 and 2016 were studied. Primary outcome was adjusted 3-day ED revisit rates resulting in admission. All revisits, regardless of disposition, served as a secondary outcome. Average treatment effects were estimated by using inverse probability weighted regression, with adjustment for demographic factors, diagnostic testing, ED medications, and hospital-level factors.

RESULTS: We studied 29 919 children with a median age of 8.6 (interquartile range: 5.1–13.8) months. Of those studied, 36% of the children received parenteral antibiotics before discharge. Patients who received parenteral antibiotics had similar adjusted rates of revisits leading to admission as those who did not receive parenteral antibiotics (1.3% vs 1.0%, respectively; risk difference: 0.3% [95% confidence interval: −0.01% to 0.6%]), although overall revisit rates were higher among patients who received parenteral antibiotics (4.8% vs 3.3%; risk difference 1.5% [95% confidence interval: 0.9% to 2.1%]).

CONCLUSIONS: Among discharged patients, a parenteral dose of antibiotics did not reduce revisits leading to admission, supporting the goal of discharging patients with oral antibiotics alone for most children with UTIs.

Link: http://pediatrics.aappublications.org/content/early/2018/08/17/peds.2018-0900?utm_source=highwire&utm_medium=email&utm_campaign=Pediatrics_papetoc#T1