LA CONSULTA SEMANAL

SEPTIEMBRE 2000

CONSULTA

CMAJ 2000 Sep 5;163(5):523-9
Evaluating the benefits of antimicrobial prophylaxis to prevent urinary tract infections in children: a systematic review.
Le Saux N, Pham B, Moher D
Thomas C. Chalmers Centre for Systematic Reviews, Children's Hospital of Eastern Ontario Research Institute, Ottawa. lesaux@cheo.on.ca
BACKGROUND: The recurrence rate for urinary tract infections in children is estimated at between 30% and 40%. The use of low doses of antibiotics as prophylaxis for recurrent urinary tract infections is common clinical practice. However, prolonged antimicrobial therapy has the potential to contribute to problems of bacterial resistance and antimicrobial side effects. The aim of this review was to systematically examine the available evidence for the effectiveness of this intervention. METHODS: We conducted a literature search of 3 electronic databases for the period 1966 to 1999. We also searched bibliographies from conference proceedings and contacted content experts to ensure completeness of our database. Each trial was evaluated on the basis of the following inclusion criteria: target population (children), intervention (antibiotic v. no antibiotic), outcome (number of urinary tract infections) and study design (randomized controlled trial). Quality was assessed for the studies that met these criteria. RESULTS: Most of the studies identified were case series and cohort studies. Only 6 randomized trials fulfilled the inclusion criteria. All were of low quality (median 2, range 0 to 2 [maximum quality score 5]). Three trials dealt with children who had anatomically normal urinary tracts, and three included children with neurogenic bladder. The rate of infections for patients with normal urinary tracts ranged from 0 to 4.0 per 10 patient-years for the treatment groups and from 4.0 to 16.7 for the control groups. The recurrence rates for patients with neurogenic bladders in 2 trials were 2.9 and 17.1 per 10 patient-years for the treatment groups and 1.5 and 33.0 for the control groups. INTERPRETATION: The available evidence for using antimicrobial prophylaxis to prevent urinary tract infection in children with normal urinary tracts or neurogenic bladder is of low quality. This suggests that the magnitude of any benefit should at best be questioned. The surprising lack of data for children with reflux is of concern. Well-designed trials are needed to optimize the use of antimicrobials in children with recurrent urinary tract infection.

Arch Dis Child 2000 Aug;83(2):135-7
Detrusor instability; day and night time wetting, urinary tract infections.
Fisher R, Frank D
Royal Bristol Hospital for Sick Children, St Michael's Hill, Bristol BS2 8BJ, UK.
Publication Types:
  Review
  Review, tutorial

Surg Clin North Am 2000 Jun;80(3):895-909, ix-x
Contemporary issues with bacterial infection in the intensive care unit.
Reed RL 2nd
Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
Nosocomial infection in the critically ill results from defects in the intrinsic barriers to microbial invasion. The diagnosis is complicated by an inability to perform an adequate physical examination in a patient with several compounding findings, usually necessitating sophisticated technologies to aid in the diagnosis. Pneumonia, line sepsis, urosepsis, sinusitis, endocarditis, peritonitis, and acalculous cholecystitis are the more common infections that challenge the care of the critically ill. Antibiotic therapy is adjunctive to efforts to preserve the barrier, but should be started early, should be targeted as specifically as possible to the offending organisms, and should be dosed adequately to ensure an effective concentration in the infected tissue.
Publication Types:
  Review
  Review, tutorial

Clin Infect Dis 1999 Apr;28(4):723-5
Factors contributing to susceptibility of postmenopausal women to recurrent urinary tract infections.
Stamm WE, Raz R
University of Washington School of Medicine, Seattle, USA.
Recurrent urinary tract infections (UTIs) account for substantial morbidity, losses in work time, and medical costs. Recent studies suggest that the major factors predisposing to recurrent UTIs differ by age and functional status. In premenopausal women, sexual intercourse, spermicide exposure, maternal history
of UTI, and a history of UTI in childhood have been associated with recurrent infections. In postmenopausal women, lack of estrogen appears to be an important factor predisposing to recurrent UTI, as does nonsecretor status, a history of UTI in the premenopausal period, incontinence, presence of a cystocele, and postvoid residual urine. In older women who are institutionalized, catheterization, incontinence, antimicrobial exposure, and functional status are most strongly related to risk of recurrent UTI. Further research is needed to better identify measures for prevention of recurrent UTI, which likely differ by age group.
Publication Types:
  Review
  Review, tutorial

West J Med 2000 Mar;172(3):201-5
Dysuria in adolescents.
Claudius H
Department of Emergency Medicine, Mattel Children's Hospital, UCLA 90095-1752, USA. iclaudiu@ucla.edu
Publication Types:
  Review
  Review, tutorial

Arch Esp Urol 2000 Jan-Feb;53(1):15-20
[Cystic pyeloureteritis and infection. Presentation forms and review of the literature].
Navas Pastor J, Morga Egea JP, Garcia Ligero J, Garcia Garcia F, Tomas Ros M, Rico Galiano JL, Sempere Gutierrez A, Guzman Martinez Valls PL, Gil Franco J, Fontana Compiano LO
Servicio de Urologia, Hospital General Universitario, Murcia, Espana.
OBJECTIVE: To present three illustrative cases of pyeloureteritis cystica and review the literature. METHODS: Three illustrative cases diagnosed at our department are described. Patient history, clinical features, diagnostic procedures and treatment are analyzed and the literature is reviewed. RESULTS: Our patients had no specific symptoms. All three patients had urinary tract infection with pyeloureteral involvement, which was bilateral in two cases. One of these patients had a long-indwelling catheter. CONCLUSIONS: Pyeloureteritis cystica is a benign and uncommon condition whose etiology is not well-known. It is generally associated with chronic infection and inflammation, and may be difficult to distinguish from other filling defects of the urinary tract. Due to its benign nature, treatment must always be conservative and close follow-up is recommended.
Publication Types:
  Review
  Review of reported cases

Am Fam Physician 2000 Feb 1;61(3):713-21[Texto completo]
Published erratum appears in Am Fam Physician 2000 Jun 15;61(12):3567
Urinary tract infections during pregnancy.
Delzell JE Jr, Lefevre ML
Health Sciences Center, University of Missouri-Columbia School of Medicine, 65212, USA.
Urinary tract infections are common during pregnancy, and the most common causative organism is Escherichia coli. Asymptomatic bacteriuria can lead to the development of cystitis or pyelonephritis. All pregnant women should be screened for bacteriuria and subsequently treated with antibiotics such as nitrofurantoin, sulfisoxazole or cephalexin. Ampicillin should no longer be used in the treatment of asymptomatic bacteriuria because of high rates of resistance. Pyelonephritis can be a life-threatening illness, with increased risk of perinatal and neonatal morbidity. Recurrent infections are common during pregnancy and require prophylactic treatment. Pregnant women with urinary group B streptococcal infection should be treated and should receive intrapartum prophylactic therapy.
Publication Types:
  Review
  Review, tutorial

Enferm Infecc Microbiol Clin 1999 Dec;17(10):521-6
[Urinary infection in the elderly].
[Article in Spanish]
Herrera J
Geriatria, Equipo de Valoracion Geriatrica, Hospital Nuestra Senora del Prado, Talavera de la Reina, Toledo.
Publication Types:
  Review
  Review, tutorial

Hosp Pract (Off Ed) 2000 Jan 15;35(1):53-9; discussion 59-60; quiz 144 [Texto completo]
Managing urinary tract infections in men.
Lipsky BA
University of Washington School of Medicine, USA.
Despite the obvious genitourinary differences between the sexes, management of lower urinary tract infections in men is based largely on standards developed from studies in women. This has helped foster misconceptions that, among other problems, add needless complexity and expense to diagnosis and treatment of male patients.
Publication Types:
  Review
  Review, tutorial

Pediatr Clin North Am 1999 Dec;46(6):1111-24, vi
Urinary tract infection in the pediatric patient.
Shaw KN, Gorelick MH
Department of Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, USA.
Little attention has been focused on the identification of urinary tract infection (UTI) in young febrile children in the emergency department, despite recent information that suggests both a high prevalence and significant associated morbidity in this population. Most UTIs that lead to scarring or diminished kidney growth occur in children younger than age 4 years, especially babies in the first year of life. Overall, prevalence rates of UTI in febrile infants in the emergency department are approximately 3% to 5%, with higher rates for white girls, uncircumcised boys, and those without another potential source for fever. Prevalence and risk factors are given so that clinicians may identify those febrile children at particularly high or low risk of UTI for selective management. Culturing methods, urine screening tests, and culture interpretation are reviewed and management strategies based on these results are suggested.
Publication Types:
  Review
  Review, tutorial

BMJ 1999 Oct 30;319(7218):1173-5 [Texto completo]
Urinary tract infection in children.
Larcombe J
Sedgefield, County Durham TS21 3BN. Jhlarcombe@aol.com
Publication Types:
  Review
  Review literature

Urol Clin North Am 1999 Nov;26(4):779-87
Urinary tract infections in pregnancy.
Connolly A, Thorp JM Jr
Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, USA.
Although pregnancy does not increase the prevalence of ASB in women, it does enhance the progression rate from asymptomatic to symptomatic disease. Furthermore, ASB is associated with preterm delivery. Given the fact that identification and eradication of ASB in pregnant women can lower the likelihood of pyelonephritis and prevent preterm delivery, every gravida should be systematically screened for ASB and appropriately treated. In the authors' opinion, a first-trimester urine culture remains the screening test of choice; reliance on symptoms to prompt screening is inadequate because the state of pregnancy can provoke frequency and nocturia. Multiple antibiotic regimens for ASB are safe during pregnancy and effective.
Publication Types:
  Review
  Review, tutorial

Urol Clin North Am 1999 Nov;26(4):753-63
Management of pyelonephritis and upper urinary tract infections.
Roberts JA
Department of Urology, Tulane University School of Medicine, New Orleans, Louisiana, USA.
The most frequent cause of upper urinary tract infection remains E. coli. Other organisms are found in complicated infections associated with diabetes mellitus, instrumentation, stone, and immunosuppression. The pathogenesis of acute pyelonephritis is reviewed herein, with an emphasis on the virulence factors responsible for its initiation, including urothelial adhesion by P-fimbriae of E. coli and other common factors including hemolysin and aerobactin. Renal damage does not always ensue following such infection. It is seen when toxic oxygen radicals are released during the ischemic episode and the respiratory burst of phagocytosis is marked and prolonged. These events occur when effective antibacterial treatment is delayed when the diagnosis is not made early or when socioeconomic factors prevent treatment. The scarring of chronic pyelonephritis leads to the loss of renal tissue and function and may progress to end-stage renal disease. With effective antibacterial therapy, the immune response by both T and B lymphocytes leads to antibodies that assist in bacterial eradication Therapy must be both rapid and effective. In many instances, antibacterial agents may be used as outpatient therapy. If the Gram stain shows only gram-negative organisms and if the infection is community acquired, oral outpatient therapy with trimethoprim/sulfamethoxazole or a fluoroquinolone may suffice if the patient has no nausea. When the patient is septic, hospitalization and treatment with parenteral antibiotics are needed. Both ceftriaxone and gentamycin are cost-effective parenteral therapy because only once-daily dosing is needed. If gram-positive organisms are found, an enterococcus should be suspected, and a beta-lactam penicillin such as piperacillin or a third-generation cephalosporin such as ceftriaxone is indicated. If penicillin allergy exists, vancomycin should be used. If the patient does not improve rapidly, diagnostic studies including ultrasound and CT will assist in the diagnosis of obstruction, abscess, or emphysematous pyelonephritis. Most of these complications are now rapidly treated percutaneously, with surgical therapy following as needed. Complicated infections, such as those occurring in patients with anatomic abnormalities, stone, or immunosuppression, are often caused by organisms other than E. coli, and long-term antibacterial therapy often leads to fungal infections such as candidiasis. A recrudescence of tuberculosis is occurring, often with resistance to antituberculous drugs. The increased incidence has been associated with the immunosuppression of AIDS but is also occurring in intravenous drug users, perhaps because of poor nutrition but also owing to noncompliance with treatment. The symptoms of renal tuberculosis are usually limited to fever, frequency, urgency, and dysuria. Hematuria with sterile pyuria is the usual laboratory finding. The young urologist should remember this renal disease in the differential diagnosis of hematuria, because medical therapy can provide a cure.
Publication Types:
  Review
  Review, tutorial

Urol Clin North Am 1999 Nov;26(4):729-35, viii
Management of lower urinary tract infections and cystitis.
Anderson RU
Department of Urology, Stanford University School of Medicine, California, USA. rua@Ieland.stanford.edu
It is possible to understand the pathophysiology, diagnostic laboratory methodology, and appropriate medical and surgical management of urinary tract infections in today's modern medical world. The foundation of success lies within an appropriate determination of the presence of mitigating complications, careful documentation of invading organisms, and judicious selection and administration of modern antimicrobial agents. Virtually all urinary tract infections begin in the lower system through bacterial exposure and adherence phenomena, creating simple uncomplicated infections in otherwise healthy hosts and serious complicated infections in others. Not all bacteriuria should be treated, and not all infections should be treated equally; knowing the difference is the secret.
Publication Types:
  Review
  Review, tutorial

Pediatrics 1999 Nov;104(5):e54
Screening tests for urinary tract infection in children: A meta-analysis.
Gorelick MH, Shaw KN
Division of Emergency Medicine, A. I. duPont Hospital for Children, Wilmington, Delaware 19899, USA. mgorelic@nemours.org
OBJECTIVE: To review systematically and to summarize the existing literature regarding performance of rapid diagnostic tests for urinary tract infection (UTI) in children. DESIGN: Systematic review and meta-analysis. METHODS: Published articles reporting the performance of urine dipstick tests (leukocyte
esterase [LE] and/or nitrite), Gram stain, or microscopic analysis of spun or unspun urine in the diagnosis of UTI in children </=12 years of age. Articles were identified through a comprehensive MEDLINE search, and those articles meeting a priori inclusion criteria were selected. Eligibility criteria included the use of urine culture as the reference standard, independent comparison of urine culture with the results of one of the screening tests, definition of positive screening test results provided, only pediatric patients included or evaluable separately, and both gold standard and screening test performed on all patients. For each test, heterogeneity of reported sensitivity and specificity of all studies was determined. The subgroups of studies with similar definitions of UTI and age of study subjects were analyzed separately to account for some of the differences in reported results. When significant unexplained heterogeneity among studies precluded simple combining of results, a summary receiver-operator characteristic curve was fitted for each screening test, from which pooled estimates of true-positive rate (TPR; ie, sensitivity) and false-positive rate (FPR; 1-specificity) were calculated. PRIMARY RESULTS: A total of 1489 titles were identified by the MEDLINE search; 26 articles met all criteria for inclusion. There was significant heterogeneity among studies for nearly all tests for both TPR and FPR, which was explained only partially by the stringency of the definition of UTI or age of subjects studied. Based on the pooled estimates, the presence of any bacteria on Gram stain on an uncentrifuged urine specimen had the best combination of sensitivity (0.93) and FPR (0.05). Urine dipstick tests performed nearly as well, with a sensitivity of 0.88 for the the presence of either LE or nitrite and an FPR of 0.04 for the presence of both LE and nitrite. Pyuria had lower TPR and higher FPR: for presence of >5 white blood cells/high-power field in a centrifuged urine sample, the TPR was 0.67 and the FPR was 0.21, whereas for >10 white blood cells per mm(3) in uncentrifuged urine, the TPR was 0.77 and the FPR was 0.11. CONCLUSIONS: Both Gram stain and dipstick analysis for nitrite and LE perform similarly in detecting UTI in children and are superior to microscopic analysis for pyuria.
Publication Types:
  Meta-analysis

Am Fam Physician 1999 Mar 15;59(6):1472-8, 1485-6 [Texto completo]
Pediatric urinary tract infection and reflux.
Ross JH, Kay R
Cleveland Clinic Foundation, Ohio 44195, USA.
Urinary tract infections in children are sometimes associated with vesicoureteral reflux, which can lead to renal scarring if it remains unrecognized. Since the risk of renal scarring is greatest in infants, any child who presents with a urinary tract infection prior to toilet training should be evaluated for the presence of reflux. Children who may be lost to follow-up and those who have recurrent urinary tract infections should also be evaluated. The preferred method for evaluation of urinary reflux is a voiding cystourethrogram. Documented reflux is initially treated with prophylactic antibiotics. Patients who have breakthrough infections on prophylaxis, develop new renal scarring, have high-grade reflux or cannot comply with long-term antibiotic prophylaxis should be considered for surgical correction. The preferred method of surgery is ureteral reimplantation. A newer method involves injection of the bladder trigone with collagen.
Publication Types:
  Review
  Review, tutorial

Am J Med 1999 Mar;106(3):327-34
Prostatitis and urinary tract infection in men: what's new; what's true?
Lipsky BA
University of Washington School of Medicine, and Antibiotic Research Clinic, Veterans Affairs Puget Sound Health Care System, Seattle 98108, USA.
Urinary tract and prostatic infections are common in men, and most are treated by primary providers. Acute bacterial prostatitis is caused by uropathogens, presents with a tender prostate gland, and responds promptly to antibiotic therapy. Chronic bacterial prostatitis is a subacute infection, may present with a variety of pelvic pain and voiding symptoms, and is characterized by recurrent urinary tract infections. Effective treatment may be difficult and requires prolonged antibiotic therapy. Nonbacterial prostatitis and chronic pelvic pain syndrome are more common than bacterial prostatitis, and their etiologies are largely unknown. Treatment for both nonbacterial disorders is primarily symptomatic. An underlying anatomic or functional condition usually complicate urinary tract infections in men, but uncomplicated infections occur, often related to sexual activity. Gram-negative bacilli cause most urinary tract and prostate infections. Therapy for prostatic infections requires an agent that penetrates prostatic tissue and secretions, such as trimethoprim-sulfamethoxazole or, preferably, a fluoroquinolone. Duration of antibiotic therapy is typically 1 to 2 weeks for cystitis, 4 weeks for acute bacterial prostatitis, and 6 to 12 weeks for chronic bacterial prostatitis. Long-term suppressive antibiotic therapy and nonspecific measures aimed at palliation may be useful in selected patients with recurrent bacteriuria or persistent symptoms of chronic bacterial prostatitis.
Publication Types:
  Review
  Review, tutorial

Am Fam Physician 1999 Mar 1;59(5):1225-34, 1237
Urinary tract infections in adults.
Orenstein R, Wong ES
Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia 23249, USA.
Urinary tract infections remain a significant cause of morbidity in all age groups. Recent studies have helped to better define the population groups at risk for these infections, as well as the most cost-effective management strategies. Initially, a urinary tract infection should be categorized as complicated or uncomplicated. Further categorization of the infection by clinical syndrome and by host (i.e., acute cystitis in young women, acute pyelonephritis, catheter-related infection, infection in men, asymptomatic bacteriuria in the elderly) helps the physician determine the appropriate diagnostic and management strategies. Uncomplicated urinary tract infections are caused by a predictable group of susceptible organisms. These infections can be empirically treated without the need for urine cultures. The most effective therapy for an uncomplicated infection is a three-day course of trimethoprim-sulfamethoxazole. Complicated infections are diagnosed by quantitative urine cultures and require a more prolonged course of therapy. Asymptomatic bacteriuria rarely requires treatment and is not associated with increased morbidity in elderly patients.
Publication Types:
  Review
  Review, tutorial

Urol Clin North Am 1998 Nov;25(4):685-701, x
Evaluation of and antimicrobial therapy for recurrent urinary tract infections in women.
Engel JD, Schaeffer AJ
Department of Urology, Northwestern University Medical School, Chicago, Illinois, USA.
The problem with recurrent urinary tract infections in women is enormous and contributes significantly to national health care costs. As the role of office urology and the external "cost-effective" pressures placed on the practicing urologist have heightened, a consistent, logical approach towards diagnosis and management of urinary tract infection becomes essential. This article briefly discusses the cause and pathophysiology behind recurrent urinary tract infections in women. A practical discussion of proper evaluation and treatment options will also be provided in hopes of offering the clinician a simple, stepwise approach to this sometimes difficult condition.
Publication Types:
  Review
  Review, tutorial

Drugs 1998 Nov;56(5):895-928
Ofloxacin. A reappraisal of its use in the management of genitourinary tract infections.
Onrust SV, Lamb HM, Balfour JA
Adis International Limited, Auckland, New Zealand. demail@adis.co.nz
Ofloxacin is an established fluoroquinolone agent which achieves good concentrations in genitourinary tract tissues and fluids. It has good in vitro activity against most Enterobacteriaceae, Staphylococcus saprophyticus, methicillin-susceptible S. aureus, Neisseria gonorrhoeae, Chlamydia trachomatis and Haemophilus ducreyi, intermediate activity against Ureaplasma urealyticum and most enterococci, but limited or no in vitro activity against enterococci, Serratia marcescens, Pseudomonas aeruginosa and many anaerobes. However, high concentrations achieved in the urine ensure its activity against most urinary tract pathogens. Ofloxacin demonstrates consistent efficacy in a broad range of urinary tract infections, achieving bacteriological response rates in excess of 80% in uncomplicated and 70% in complicated infections. The efficacy of ofloxacin was similar to that of all comparators tested including other fluoroquinolones, cephalosporins and cotrimoxazole (trimethoprim/sulfamethoxazole). Ofloxacin is also effective as a single-dose regimen in the treatment of uncomplicated gonorrhoea, as a 7-day regimen in uncomplicated C. trachomatis infections, and as monotherapy in uncomplicated pelvic inflammatory disease (PID). Again, ofloxacin demonstrated similar efficacy to alternative treatments in each type of infection. The availability of an intravenous formulation and near-complete oral bioavailability allow ofloxacin to be administered as a sequential regimen without loss of activity. The tolerability and drug interaction profile of ofloxacin is consistent with that of other fluoroquinolones. The most commonly reported adverse events with ofloxacin are gastrointestinal, neurological and dermatological. It was associated with a lower incidence of photosensitivity and tendinitis and higher incidence of some neurological events than some other fluoroquinolones. Ofloxacin seems to have a lower propensity to interact with xanthines than other fluoroquinolones. Conclusion: ofloxacin has established efficacy in the treatment of a wide variety of urinary tract infections, although, like other fluoroquinolones, it should be used rationally to preserve its activity. Currently, ofloxacin also holds an important place among fluoroquinolones in the treatment of C. trachomatis infections and uncomplicated PID, although its acceptance as monotherapy in PID is likely to depend on clarification of the causative role of anaerobic pathogens in this infection.
Publication Types:
  Review
  Review, academic

Clin Obstet Gynecol 1998 Sep;41(3):744-54
Urinary tract infections.
Faro S, Fenner DE
Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois, USA.
Urinary tract infection in women has its origin, predominantly, via ascending bacteria from the periurethral microflora. Asymptomatic bacteriuria, except for the pregnant patient, need not be treated. E. coli is the most common bacterium to cause UTIs, and is usually susceptible to oral antibiotics. Patients who are hospitalized with an indwelling Foley catheter or who have undergone instrumentation, tend to be infected with a bacterium other than E. coli. Patients with uncomplicated cystitis can effectively be treated with an oral antibiotic (Table 1) for 3 days. Patients who do not respond to empiric therapy have a recurrence within 2 weeks of treatment, or who have a recurrence within the first week after treatment, should have a pretreatment.
Publication Types:
  Review
  Review, tutorial

Am Fam Physician 1998 May 15;57(10):2440-6, 2452-4
Urinary tract infections in children: why they occur and how to prevent them.
Hellerstein S
University of Missouri-Kansas City School of Medicine, USA.
Urinary tract infections (UTIs) usually occur as a consequence of colonization of the periurethral area by a virulent organism that subsequently gains access to the bladder. During the first few months of life, uncircumcised male infants are at increased risk for UTIs, but thereafter UTIs predominate in females. An
important risk factor for UTIs in girls is antibiotic therapy, which disrupts the normal periurethral flora and fosters the growth of uropathogenic bacteria. Another risk factor is voiding dysfunction. Currently, the most effective intervention for preventing recurrent UTIs in children is the identification and treatment of voiding dysfunction. Imaging evaluation of the urinary tract following a UTI should be individualized, based on the child's clinical presentation and on clinical judgment. Both bladder and upper urinary tract imaging with ultrasonography and a voiding cystourethrogram should be obtained in an infant or child with acute pyelonephritis. Imaging studies may not be required, however, in older children with cystitis who respond promptly to treatment.
Publication Types:
  Review
  Review, tutorial
Comments:
  Comment in: Am Fam Physician 1998 May 15;57(10):2337-8, 2340


Am Fam Physician 1998 Apr 1;57(7):1573-80, 1583-4
Evaluation and treatment of urinary tract infections in children.
Ahmed SM, Swedlund SK
Wright State University School of Medicine, Dayton, Ohio, USA.
Urinary tract infections (UTIs) are among the most common bacterial infections encountered by primary care physicians. Although UTIs do not occur with as great a frequency in children as in adults, they can be a source of significant morbidity in children. For reasons that are not yet completely understood, a minority of UTIs in children progress to renal scarring, hypertension and renal insufficiency. Clinical presentation of UTI in children may be nonspecific, and the appropriateness of certain diagnostic tests remains controversial. The diagnostic work-up should be tailored to uncover functional and structural abnormalities such as dysfunctional voiding, vesicoureteral reflux and obstructive uropathy. A more aggressive work-up, including renal cortical scintigraphy, ultrasound and voiding cystourethrography, is recommended for patients at greater risk for pyelonephritis and renal scarring, including infants less than one year of age and all children who have systemic signs of infection concomitant with a UTI. Antibiotic prophylaxis is used in patients with reflux or recurrent UTI who are at greater risk for subsequent infections and complications.
Publication Types:
  Review
  Review, tutorial