Use of an Initial Dose of a Parenteral versus Oral Antibiotic with Discharge Home from the ED for UTI :

If a child between 1 month and 2 years of age is diagnosed in the emergency department (ED) with a urinary tract infection (UTI), would you give an initial dose of a parenteral antibiotic or simply send the patient home on an oral antibiotic? Chaudhari et al. (10.1542/peds.2018-0900) decided to seek an answer to that question by performing a retrospective analysis on 29, 929 children diagnosed with a UTI in one of 36 children’s hospitals between 2010 and 2016.  The primary outcome was a revisit to the ED within 3 days of the initial visit resulting in an admission although all revisits were also reported.  36% of children sent home with a UTI received parenteral antibiotics prior to going home.  You may be surprised to learn that when it came to revisits, there was no difference in those who got parenteral antibiotics and those who were only treated orally. There is a lot more to learn from this interesting study so go with the flow of information, take a pee-k and learn more.  The lack of benefit of parenteral antibiotics although retrospectively determined, may be enough to convince you to send patients home from your office or the ED on oral antibiotics in the setting of a UTI.  If it’s not enough, tell us what it would take to change the way you practice by responding to this blog, the article on our website or by posting a comment on our Facebook or Twitter pages.