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[Choice of treatment in recurrent urinary infections in childhood]
Insights
Recurrent urinary tract infections in children were treated with trimethoprim-sulfamethoxazole (TMP-SMZ) alone or combined with nitrofurantoin or nalidixic acid. Combined therapies showed better results, likely due to high TMP-SMZ resistance.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial resistance
- Urology
Context:
- Recurrent urinary tract infections (UTIs) pose a significant health challenge in children.
- Antibiotic resistance is a growing concern in managing pediatric UTIs.
- Evaluating alternative and combination therapies is crucial for effective treatment.
Purpose:
- To compare the efficacy of trimethoprim-sulfamethoxazole (TMP-SMZ) monotherapy versus combination therapy with nitrofurantoin or nalidixic acid for recurrent UTIs in children.
- To assess the impact of pre-existing TMP-SMZ resistance on treatment outcomes.
Summary:
- Forty-two children with recurrent UTIs were treated in three groups: TMP-SMZ alone, TMP-SMZ with nitrofurantoin, or TMP-SMZ with nalidixic acid.
- All treatment groups showed a significant reduction in UTI frequency (p < 0.001).
- The combination therapy groups (nitrofurantoin or nalidixic acid) demonstrated superior outcomes with fewer treatment failures and lower UTI recurrence rates, attributed to a high observed resistance (72.07%) to TMP-SMZ.
Impact:
- Combination antibiotic therapy can be more effective than monotherapy for recurrent pediatric UTIs, especially in areas with high antimicrobial resistance.
- Findings highlight the importance of susceptibility testing and considering alternative agents like nitrofurantoin and nalidixic acid.
- This study informs clinical practice guidelines for managing recurrent UTIs in pediatric populations facing antimicrobial resistance challenges.
Abstract:
Forty-two cases of children showing recurrent urinary tract infection were treated. Three treatment guides were used: the first group of children were given trimetoprim-sulphametoxazole (TMP-SMZ) only, the second and third ones were treated with TMP-SMZ and alternative nitrofurantoine in the former or nalidixic acid in the latter. After treatment a meaning reduction in frequency of urinary tract infection cases (p less than 0.001) were observed. Best results (lesser percentage of failures and lesser number of urinary tract infection cases per month of observation) were achieved in the second and third groups, probably due to a high percentage of resistance cases against TMP-SMZ found during prophylactic treatment (72.07).