Persistent use of broad-spectrum antibiotics for suspected community acquired urinary tract infections in children in Italian primary care settings

Background: Urinary tract infections (UTIs) are common in children, and diagnosis is often difficult due to nonspecific symptoms, urine collection challenges, and increasing antimicrobial resistance. The emergence of ESBL-producing organisms highlights the need for locally informed guidelines supported by antibiotic stewardship activities. This study aimed to describe antibiotic prescribing patterns for suspected community-acquired UTIs (CA-UTIs) in the Italian primary care setting among children aged 0–14 years and to assess the impact of the 2019 Italian Society of Paediatric Nephrology (SINePe) guidelines update on prescribing behaviour in children aged 2 months to 3 years. Methods: We conducted a database analysis including Italian children aged 0–14 years between 2015 and 2024 using data from the Pedianet database, which contains anonymized electronic health records of over 275,000 children. CA-UTI episodes were identified through ICD-9-CM codes and free-text searches, then manually validated. All antibiotic prescriptions (classified by ATC codes and AWaRe classification) issued during each episode and associated to the CA-UTI were included. An interrupted time-series (ITS) analysis using a Poisson model was conducted to evaluate the impact of the 2019 national consensus guidelines on yearly antibiotic prescribing patterns in children aged 2 months to 3 years with a first episode of CA-UTI. Results: From 2015 to 2024, 32,519 suspected CA-UTI episodes in 26,650 children were included. The majority of children experienced a single episode (79.9%). Co-amoxiclav was the most frequently prescribed antibiotic, followed by third-generation cephalosporins, which remained common across the study period. Fosfomycin use increased with age and was more frequent among older children. Over 2550 first CA-UTI episodes were included in the ITS analysis showing no significant changes in prescribing patterns following the 2019 guideline update. Similar trends were confirmed when restricting the analysis to empiric antibiotic treatments. Conclusion: Co-amoxiclav remains the first-line empiric therapy for paediatric CA-UTIs in Italian primary care, although third-generation cephalosporins are still frequently prescribed despite revised recommendations. These findings highlight the need for continued antimicrobial stewardship efforts and monitoring to optimize paediatric UTI management in the community setting.