Introduction

Urinary tract infection due to resistant strains have increased with the use of antibiotics, resulting in unsatisfactory clinical therapeutic outcomes and a high recurrence rate of about 18.9%. Cefixime, a broad-spectrum antibiotic of the cephalosporin family has good antibacterial effects on various bacilli and cocci and is also highly stable to multiple β-lactamases.

Aim

To investigate the effects of cefixime on immune functions and inflammatory factors in children with urinary tract infection and study its nursing strategies

Patient Profile

N=161 children with urinary tract infection were included (2019-2020)

Methods

• All children received oral treatment of Cefixime
• Dose was adjusted according to children’s weight and severity of the disease, with 8 mg/kg at one time and twice a day for 10 consecutive days
• Nursing strategies included valuing the emotional reassurance of children, guidance of medication, regular ventilation to keep fresh air and suitable temperature in wards and dietary guidance

Study endpoints

• Indices of immune functions (levels of CD3+,CD4+, CD8+ and CD4+/CD8+)
• Indices of inflammatory factors: C-reactive protein (CRP), Tumour Necrosis Factor alpha (TNF-α) and Interleukin 6 (IL-6)
• Situation of nursing satisfaction (electronic questionnaire to assess the satisfaction of children and their families)
• Recurrence within 6 months after treatment
• Adverse reactions

Results

Indices of Immune Function

• Levels of CD3+, CD4+ and CD4+/CD8+ in children after the treatment were significantly higher
• CD8+ level was significantly lower than those before the treatment (p < 0.001)

Fig 1: Comparison of immune function indices before and after treatment (Mean ± SD)

	Before treatment	After treatment	Z value	P value
CD3 + (%)	54.47 ± 6.51	65.44 ± 5.09	–12.162	<0.001
CD 4 + (%)	38.15 ± 4.51	41.96 ± 4.90	–6.284	<0.001
CD 8 + (%)	27.74 ± 2.56	24.08 ± 2.64	–10.065	<0.001
CD4+/CD8+	1.39 ± 0.21	1.77 ± 0.29	–10.727	<0.001

 

Indices of Inflammatory Factors

The levels of CRP, TNF-α and IL-6 in children after the treatment were lower than those before the treatment (p < 0.001)

Fig 2: Comparison of inflammatory factor indices before and after treatment (Mean ± SD)

	Before treatment	After treatment	Z value	P value
CRP (mg/L)	11.65 ± 2.44	5.75 ± 1.69	–14.946	<0.001
TNF-α (pg/mL)	3.45 ± 1.00	3.45 ± 0.55	–13.792	<0.001
IL-6 (pg/mL)	8.22 ± 2.09	4.77 ± 1.18	–12.732	<0.001

 

Nursing Satisfaction

Average score of nursing satisfaction of children’s family members was (84.53 ± 13.65) points and the total satisfaction degree was 90.68%.

Rate of Recurrence

Recurrence rate was 3.73% (n=6 patients had UTI again within 6 months after the treatment)

Adverse Reactions

During the treatment, only n=7 children had adverse reaction (4.35%) with dizziness as main adverse reaction in 3 children.

Conclusion

• Cefixime stimulates the immune system of children with UTI and decreases the number of inflammatory factors
• Targeted nursing strategies can increase clinical satisfaction and decrease the rate of disease recurrence, which can help to create a comprehensive and effective clinical plan for children with UTI

Reference

Arch. Esp. Urol. 2023; 76(5): 313–318