Urinary Alkalinizers in Children

• Generally in children confirmed to suffer from Urinary Tract Infections, an empiric antibiotics therapy is needed
• Guidelines do not recommend the use of urinary alkalinizers for treatment of UTI in children
• However, it is indicated in order to increase the renal excretion of toxic substances such as salicylates or lithium, renal tubular acidosis and nephrolithiasis

Potassium Citrate 

• Zontron: (3g potassium Citrate in 10ml)
• There is no pediatric recommendations based on our available products
• However, based on other available products:
• Children 1 - 6 years: 5ml three times a day
• It should be taken well diluted with water, after meals. Shake the bottle before use.
•  > 6 years (3g BD-TDS) (Frank Shann)

Sodium citrate/citric acid

• UTIX: (720mg citric acid, 630mg sodium citrate, 1760 sodium bicarbonate)
• There is no paediatric recommendations based on our available products
• Based on other products (500 mg sodium citrate/334 mg citric acid per 5 mL )
• Children 2 yr of age and older (5 to 15 mL), diluted in 1 to 3 oz of water, after meals and at bedtime, or as directed by health care provider.

Sodium Bicarbonate

• Injection sodium Bicarbonate 8.4% (1mmol/ml)
• No ready made preparations/ pediatric oral dose recommendations 
• Based on other products:
• 0 to 12 years: 1 to 10 mEq (84 to 840 mg)/kg/day orally in divided doses; dose should be titrated to desired urinary pH.
• Greater than 12 to 18 years: 325 to 2000 mg orally 1 to 4 times a day. One gram provides 11.9 mEq (mmol) each of sodium and bicarbonate.
• @
• 0.25mmol/kg 6-12H oral (Frank Shann)

Recommendations based on available guidelines on UTI

• Asymptomatic bacteriuria in infants and children should not be treated with antibiotics. 
• Symptomatic cases should be treated with antibiotics
• Urinary alkalinizers are generally not indicated for children for treatment of UTI

References:

1. Drug Doses 2014
2. http://www.nice.org.uk/guidance/cg54/chapter/1-recommendations
3. https://www.medicines.org.uk/emc/medicine/25386
4. http://www.drugs.com/dosage/sodium-bicarbonate.html
5. http://www.drugs.com/dosage/potassium-citrate.html
6. http://www.drugs.com/ppa/sodium-citrate-citric-acid.html