Is Cephalexin Dosing for Uncomplicated UTIs in the ED Appropriate?

Antimicrobial stewardship has driven the use of narrow spectrum antibiotics, prescribing antibiotics only when needed, and adequate dosage to resolve an illness. A poster presented at the Pediatric Pharmacy Association’s 2022 Annual Meeting held in Norfolk, Virginia evaluated cephalexin dosing for uncomplicated urinary tract infections (UTIs) in an emergency department.

The investigators performed a retrospective chart review of patients from July 2020 to July 2021 who presented at the Nationwide Children’s Hospital main campus emergency department in Columbus, Ohio. Patients aged 60 days to 18 years, had a diagnosis of uncomplicated UTI, and were prescribed cephalexin at the time of discharge met the inclusion criteria.

A total of 60 children were included in the investigation. The median patient age was 5 years; all were girls. Urine cultures had been collected for 53 of the patients. Seventeen samples had no growth, while 30 showed Escherichia coli and 6 were positive for another pathogen. Cephalexin dosage was correct for 92% of prescriptions. Forthe 5 prescriptions that had incorrect dosing, 4 were supratherapeitic and 1 was subtherapeutic. Just 1 patient in 2020 and 18 patients in 2021 were given an optimal duration of therapy.

Within 30 days of the initial emergency department visit, 7 returned to either the main campus emergency department or an affiliated urgent care center. However, none of those visits were due tothe a need to reassess the UTI. Furthermore, 41 nursing telephone follow-ups were performed, and 1 patient required a change in therapy because of the culture results.

The investigators concluded that the dosage of cephalexin in the emergency department was appropriate for the most part, but the duration was often inappropriate. Education on therapy duration is a key way to promote antimicrobial stewardship.

Reference

1. Marlo M, Jones K, Tansmore J, Steinbrenner J, Barth B. Evaluation of cephalexin dosing for treatment of uncomplicated urinary tract infections within a pediatric emergency department.Presented at: Pediatric Pharmacy Association 2022 Annual Meeting; May 3-6, 2022; Norfolk, VA.