Emergency Department Revisits After an Initial Parenteral Antibiotic Dose for UTI

Pediatrics. 2018 Sep;142(3):e20180900. doi: 10.1542/peds.2018-0900. Epub 2018 Aug 21.


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.

MeSH terms

  • Anti-Bacterial Agents / administration & dosage*
  • Child, Preschool
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Infusions, Parenteral / statistics & numerical data
  • Male
  • Patient Readmission / statistics & numerical data*
  • Retrospective Studies
  • United States
  • Urinary Tract Infections / drug therapy*


  • Anti-Bacterial Agents