Urinary tract infections(UTI) caused by extended-spectrum β-lactamase (ESBL)-producing bacteria have been increasingly recognized. And it is emerging that medical efforts need to be made to reduce the prevalence of ESBL production by the change in antibiotic policy such as the substitution of piperacillin-tazobactam for extended-spectrum cephalosporins. This study was conducted to evaluate the effect of piperacillin-tazobactam compared with cefotaxime as empirical antibiotics treatment for febrile UTI in children. Medical records of infants and children older than 3 months of age diagnosed with febrile UTI between January 2014 and December 2016 were retrospectively reviewed. Patients were grouped according to the antimicrobials they received into a cefotaxime group, a piperacillin-tazobactam group and a meropenem group. Clinical characteristics and treatment outcomes in terms of recurrent UTI were compared among the groups. Two hundred and seven infants and children (107 boys and 100 girls) were enrolled in this study. Urine cultures were proven in 153 patients (73.9%), blood cultures were isolated in 4 (1.9%), and ESBL were positive in 28 (13.5%). Seventy-seven patients (37.2%) were treated with cefotaxime, 115 (55.6%) with piperacillin-tazobactam, and 15 (7.2%) with by switching from a non-carbapenem to a carbapenem. Thirty-one patients (15%) experienced recurrent UTI. There was no significant difference in clinical characteristics among the treatment groups except for the prolonged admission period in the meropenem group. Asymmetric kidney with the right to left functional kidney ratio of less than 0.818 or greater than 1.182 in the DMSA renal scan was associated with vesicoureteral reflux and laboratory results such as the elevation of white blood cell, BUN, Cr and C-reactive protein (CRP). Treatment outcomes in terms of recurrence rate of UTI were not statistically significant difference among the treatment groups. Factors associated with recurrence of UTI were abnormal prenatal ultrasound ( P=0.000) and elevated CRP ( P=0.012). This study found no significant difference in the treatment outcome between patients treated with cefotaxime and those treated with piperacillin-tazobactam as empirical treatment for febrile UTI. Therefore, piperacillin-tazobactam can be an alternative to cephalosporins for febrile UTI in children.