Therapeutic Management
The objectives of treatment of children with UTI are to (1) eliminate the current infection, (2) identify contributing factors to reduce the risk of recurrence, (3) prevent urosepsis, and(4) preserverenal function. Antibiotic therapy is guided by laboratory culture and sensitivity tests. Nonetheless, empiric therapy on the basis of the child’s history and presenting symptoms may be necessary when fever or systemic illness complicates UTI. Common antiinfective agents used for UTI include the penicillins, sulfonamide (including trimethoprim and sulfamethoxazole in combination), the cephalosporins, nitrofurantoin, and the tetracyclines. All antibiotics may cause side effects or prove ineffective because of bacterial resistance.
Children with suspected pyelonephritis and fever are admitted to the hospital and given appropriate antibiotics intravenously for a minimum of 48 hours. Blood and urine cultures are obtained on admission and after therapy. Urine culture are usually repeated at monthly intervals for 3 months and at 3- month interval for another 6 months.
Renal scarring can develop during the initial infection, especially in younger children. Therefore some practitioners believe that the first UTI in childhood necessitates radiologic evaluation, regardless of the patient’s age sex.
Anatomic defects such as primary reflux or bladder neck obstruction may require surgical correction to prevent recurrent infection or may indicate the need for prophylactic antibiotics and careful follow-up monitoring. Follow-up study is an important component of medical management, since the relapse rate is high and recurrent infection tends to occur 1 to 2 months after termination of treatment. The aim of therapy and careful follow-up in such cases is to prevent morbidity and reduce the chance of renal scarring.
Prognosis. With prompt and adequate treatment at the time of diagnosis, the long-term prognosis for UTIs is usually excellent.
The hazard of progressive renal injury is greatest when infection occurs in young children (especially under 2 years of age) and is associated with congenital renal malformations and reflux. Therefore early diagnosis of children at risk is particularly important during infancy toddlerhood.