urinary%20tract%20infection%20(pediatric)
URINARY TRACT INFECTION (PEDIATRIC)
Nonspecific urinary tract infection symptoms in infants <3 months are fever, feeding difficulties, vomiting, lethargy, irritability and failure to thrive.
Toddlers and preschoolers have unusual odor of urine, abdominal or flank pain, frequency, dysuria, and urgency.
School-age children have the classical symptoms of fever, frequency, urgency and dysuria.
Consider UTI in all seriously ill children even when there is evidence of infection outside the urinary tract.

Prevention

  • Goal of antibiotic prophylaxis is to prevent infection, renal damage & scarring by sterilizing urine
  • Routine antibiotic prophylaxis in patients w/ first-time urinary tract infection (UTI) is not recommended
  • Asymptomatic bacteriuria in a patient w/ a normal urinary tract is not an indication for antibiotic prophylaxis
  • Antibiotic prophylaxis may reduce the number of positive urine cultures but has not been clearly shown to reduce the number of new symptomatic urinary tract infection (UTI) or new renal parenchymal defects
  • Possible drawbacks of antibiotic prophylaxis:
    • Patient inconvenience
    • Poor compliance
    • Colonization w/ resistant organisms
  • Prophylaxis may be considered in the following patients:
    • W/ history of vesicoureteral reflux (VUR)
    • Immunosuppressed
    • W/ partial urinary tract obstruction
    • W/ recurrent urinary tract infection (UTI)
  • Antibiotics used for prophylaxis should ideally be administered orally & achieve high concentrations in the urine while maintaining low fecal concentrations
  • Antibiotics that may be used for prophylaxis: Co-trimoxazole, Nalidixic acid, Nitrofurantoin, cephalosporins, fluoroquinolones

Vesicoureteral Reflux

  • Not all cases of vesicoureteral reflux (VUR) require treatment
  • Intervention for vesicoureteral reflux (VUR) does not always prevent complications
  • Long-term antibiotic therapy may be given to prevent infections in a child who is expected to outgrow reflux
  • Surgery is recommended for higher grades of reflux
    • Open surgical repair including ureteral implantation
    • Endoscopic treatment
  • Correction of dysfunctional elimination, ie constipation has been shown to decrease recurrent urinary tract infection (UTI)
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