Background:
Urinary Tract Infection (UTI) is a common infection in children. Prompt diagnosis
and appropriate treatment are very important to reduce the morbidity associated with this condition.
Objective:
To provide an update on the evaluation, diagnosis, and treatment of urinary tract infection in
children.
Methods:
A PubMed search was completed in clinical queries using the key terms “urinary tract infection”,
"pyelonephritis" OR "cystitis". The search strategy included meta-analyses, randomized controlled
trials, clinical trials, observational studies, and reviews. The search was restricted to English
literature and the pediatric age group. Patents were searched using the key terms “urinary tract infection”
"pyelonephritis" OR "cystitis" from www.google.com/patents, http://espacenet.com, and
www.freepatentsonline.com.
Results:
Escherichia coli accounts for 80 to 90% of UTI in children. The symptoms and signs are nonspecific
throughout infancy. Unexplained fever is the most common symptom of UTI during the first
two years of life. After the second year of life, symptoms and signs of pyelonephritis include fever,
chills, rigor, flank pain, and costovertebral angle tenderness. Lower tract symptoms and signs include
suprapubic pain, dysuria, urinary frequency, urgency, cloudy urine, malodorous urine, and suprapubic
tenderness. A urinalysis and urine culture should be performed when UTI is suspected. In the work-up
of children with UTI, physicians must judiciously utilize imaging studies to minimize exposure of children
to radiation. While waiting for the culture results, prompt antibiotic therapy is indicated for symptomatic
UTI based on clinical findings and positive urinalysis to eradicate the infection and improve
clinical outcome. The choice of antibiotics should take into consideration local data on antibiotic resistance
patterns. Recent patents related to the management of UTI are discussed.
Conclusion:
Currently, a second or third generation cephalosporin and amoxicillin-clavulanate are
drugs of choice in the treatment of acute uncomplicated UTI. Parenteral antibiotic therapy is recommended
for infants ≤ 2 months and any child who is toxic-looking, hemodynamically unstable, immunocompromised,
unable to tolerate oral medication, or not responding to oral medication. A combination
of intravenous ampicillin and intravenous/intramuscular gentamycin or a third-generation cephalosporin
can be used in those situations. Routine antimicrobial prophylaxis is rarely justified, but continuous
antimicrobial prophylaxis should be considered for children with frequent febrile UTI.
Escherichia coli O25b-ST131 and O16-ST131 causing urinary tract infection in women in Changsha, China: molecular epidemiology and clinical characteristics
