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Urinary tract infections (UTI) are among the most common bacterial infections of childhood. Rapid recognition and appropriate antimicrobial therapy relieve symptoms and prevent renal damage [1]. Since therapy for suspected UTI is usually initiated before the responsible organism and its susceptibility to antimicrobial agents are known, the rational choice of an antibiotic relies on local epidemiologic data. In infants and young children without a known urinary tract malformation, Escherichia coli is responsible for the vast majority of episodes [2, 3]. Recent studies suggest that in these patients intravenous antibiotic therapy for acute pyelonephritis may no longer be warranted, and that most patients can be treated safely with oral third-generation cephalosporins [3, 4]. However, since outpatient oral therapy for acute pyelonephritis requires certainty that the drug used is active against the expected pathogens, this trend is somewhat at odds with the increasing antimicrobial resistance detected among isolates of Escherichia coli in recent years [5–7]. The aim of the retrospective study reported here was to investigate changes in the antimicrobial resistance of Escherichia coli causing acute pyelonephritis in children hospitalized with a UTI during 2 decades. Two study periods were chosen for investigation. The first period from 1980 to 1991 was based on reference data provided by a previous study conducted by one of the present authors (M.G.B.) at the same study site [8]. A power

Changes in antimicrobial resistance of Escherichia coli causing urinary tract infections in hospitalized children