Urinary Tract Infection (UTI)

Kumud P Mehta
Urinary Tract Infection (UTI) - Treatment
Treatment of UTI is early institution of appropriate drug according to the antibiotic sensitivity report for a duration of 7-10 days. In sick children especially neonates and infants, intravenous antibiotics are required even before the culture report is available. The recommendation is to use Ampicillin and Gentamicin. This is the treatment given for sepsis. Delay of more than 72 hrs in starting the antibiotic can result in permanent renal damage. A 2nd urine culture after 3-5 days of antibiotic therapy should be sterile while the clinical features such as fever resolves within 2-3 days; raised ESR and CRP resolve over 2-3 weeks.

A high risk UTI is the one, which can cause permanent renal scars. The long term consequences of recurrent pyelonephritis can be multiple bilateral renal scars resulting in end stage renal disease requiring renal transplant or hypertension in young adulthood. In young females, the risk of toxaemia of pregnancy is high in those who suffered from recurrent UTI in school age. Because of these long-term complications it is mandatory to follow every infant with UTI, both males and females and every school age girl with recurrent UTI for a minimum of 20-25 years.

Management of high risk UTI consists of monitoring growth, BP recording, renal function tests, size of the kidneys by USG and periodic urine cultures.

The parents should be educated as regards the perineal hygiene especially use of diapers, cleaning the perineal region with water (not to use any antiseptics) and to toilet train the children at the age of 2-3 years, to give plenty of fluids and inculcate good habits of voiding every 3-4 hourly to prevent residual urine. These are some of the simple measures for prevention of recurrent UTI.

Children with constipation should be advised high fibre containing food and increased intake of fluids along with use of mild laxatives or suppositories because constipation is associated with recurrent UTI.

Recurrent diarrhoea can cause UTI due to the same organism because of the proximity of the rectum and the urethra.

Use of antibiotics for diarrhoea can result in resistant strains of organisms leading to recurrent UTI and since mostly the diarrhoeas are viral in origin, antibiotics should not be used indiscriminately for acute diarrhoeas of infants.

Compliance as regards the use of long term use of single night dose of co-trimoxazole or Furadantin should be observed closely by parents to prevent recurrences.

Urinary Tract Infection (UTI) Urinary Tract Infection (UTI) 01/02/2002
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