Prescribing Pattern and Efficacy of Oral Antibiotics for Pediatric Urinary Tract Infections in Japan: A Descriptive Study Using a Nationwide Claims Database

Background: Pediatric urinary tract infections are often treated with third-generation cephalosporins; however, the increasing prevalence of Escherichia coli resistant to cephalosporins has reduced their effectiveness. Although resistance is prevalent in Asia, the prescribing patterns and clinical effectiveness of antibiotics have mostly been reported in the United States. This study aimed to describe the prescription patterns and effectiveness of oral antibiotics for treating pediatric urinary tract infections in Japan.Methods: This descriptive study used data from a nationwide Japanese claims database. We identified patients <6 years old with urinary tract infections who received oral antibiotics between January 2016 and December 2020. Descriptive analyses were performed to assess prescription patterns. Moreover, logistic regression analyses were conducted to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs) for treatment failure among the commonly prescribed antibiotics and patient characteristics. Treatment failure was defined as the prescription of different antibiotics within 7 days of the primary prescription.Results: Of the 4,127 patients, 2,766 (67.0%) were prescribed third-generation cephalosporins, and 347 (8.4%) were prescribed amoxicillin. Trimethoprim-sulfamethoxazole and amoxicillin-clavulanate were prescribed to 63 (1.5%) and 50 (1.2%) patients, respectively. Treatment failure was observed in 118 (2.9%) patients and more often in amoxicillin-treated patients than in cefcapene pivoxil-treated patients [OR, 2.18 (95% CI: 1.04-4.58)].Conclusions: Third-generation cephalosporins are the most commonly prescribed antibiotics for the initial therapy of pediatric urinary tract infections in Japan. Third-generation cephalosporins are still effective in Japan, despite the high prevalence of resistance against cephalosporins.