Urinary tract infection in children.
Based on what is known of the pathogenesis of renal scarring, several therapeutic goals are important and are summarized in Figure 4. First, in children less than 5 years of age, and particularly neonates, a high index of suspicion must be combined with appropriate diagnostic techniques, including suprapubic aspiration if necessary, to obtain rapid and accurate diagnosis of urinary tract infection, thereby minimizing therapeutic delay. Although therapy can be started with broad spectrum antibiotics, culture and sensitivities are important to assure adequate antimicrobial therapy. Second, given the high incidence of vesicoureteral reflux in children with urinary tract infections, all children less than 5 years of age should have a VCUG and IV pyelogram shortly after resolution of the acute infection. In children more than 5 years of age, boys should be studied, given the very low incidence of urinary tract infection in males, and the high probability of urologic disease. Afebrile girls more than 5 years of age are exempted from diagnostic evaluation of the first episode of infection. Subsequent episodes should be investigated. Third, children with reflux should receive continuous antibiotic prophylaxis until age 6 to 8 years or until reflux resolves. Yearly evaluations are performed with radionuclide cystography, which is a nontraumatic sensitive means of detecting reflux, requiring less radiation than VCUG. Individuals of any age with recurrent urinary tract infections without reflux may benefit from a 3- to 6-month course of antimicrobial prophylaxis. Finally, antibiotic therapy should be appropriate and adjusted as necessary based the susceptibility of the bacterial pathogen. In older girls with simple uncomplicated urinary tract infections, single-dose therapy may be adequate. Younger children at increased risk for renal scarring should be treated more conservatively, receiving a 10-day course of therapy.
Stork
J E
JE
Department of Pediatrics, Case Western Reserve University, Cleveland, Ohio.
D001424:Bacterial Infections / Q000175:diagnosis / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000628:therapy