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[Urinary tract infections in pediatric practice--which new aspects must be considered?]
R Laux-End1, S Marchand, M G Bianchetti
1Ostschweizerisches Kinderspital St. Gallen.
Insights
Urinary tract infections (UTIs) are common and treated with antibiotics like cotrimoxazole. Functional voiding disorders are a key cause of recurrent UTIs in children, requiring specific investigation and management.
Area of Science:
- Urology
- Infectious Diseases
- Pediatrics
Context:
- Urinary tract infections (UTIs) exhibit variable prevalence based on sex and age.
- Colonic bacteria are the primary causative agents of UTIs.
- Acute cystitis requires prompt antibiotic treatment to prevent pyelonephritis.
Purpose:
- To outline current understanding and management strategies for urinary tract infections.
- To highlight the significance of functional voiding disorders in recurrent pediatric UTIs.
- To guide the investigation and treatment of pediatric UTIs.
Summary:
- Prompt treatment of acute cystitis with cotrimoxazole or co-amoxyclav is recommended.
- Acute febrile infections suggestive of pyelonephritis warrant broad-spectrum antibiotics like amoxicillin with an aminoglycoside.
- Functional voiding disorders, identified since the 1970s, are a major cause of recurrent UTIs in children and require tailored management.
Impact:
- Informs clinical practice regarding UTI diagnosis and treatment.
- Emphasizes the importance of identifying and managing functional voiding disorders in pediatric patients.
- Aims to reduce the incidence and impact of recurrent UTIs in children.
Abstract:
The prevalence of urinary tract infections varies markedly with sex and age. They are caused mainly by colonic bacteria. Acute cystitis should be promptly treated either with cotrimoxazol or coamoxyclav to prevent its possible progression to pyelonephritis. In acute febrile infections suggestive of pyelonephritis, the initial use of broad-spectrum antibiotics capable to reaching significant tissue levels is advised, mostly amoxycillin with an aminoglycoside. A variety of functional voiding disorders including bladder instability, detrusor-sphincter dyscoordination, postponing syndrome or lazy bladder syndrome have been identified since the early 1970s, each with its own characteristics and clinical importance. Functional voiding disorders are nowadays a major cause of recurrent urinary tract infections in children. A careful investigation to confirm or exclude functional voiding disorders is warranted in children with recurrent urinary tract infections. Management will vary according to the type and severity of the dysfunction present.