From the Guidelines
Recurrent urinary tract infections (UTIs) in children require prompt medical attention and a comprehensive management approach, with the primary goal of preventing long-term kidney damage and protecting renal function. Children with recurrent UTIs, defined as two or more episodes of UTI with acute pyelonephritis/upper tract UTI, or one episode of UTI with acute pyelonephritis/upper tract UTI plus one or more episodes of UTI with cystitis/lower tract UTI, or three or more episodes of UTI with cystitis/lower tract UTI 1, should undergo evaluation for underlying anatomical abnormalities or functional issues.
Initial Treatment and Prevention
Initial treatment involves antibiotics based on urine culture sensitivity, with common options including trimethoprim-sulfamethoxazole, amoxicillin-clavulanate, or cephalexin. For prevention, maintaining good hygiene is essential, including:
- Front-to-back wiping for girls
- Regular bathroom visits
- Adequate hydration
- Avoiding bubble baths or irritating soaps In some cases, prophylactic antibiotics at lower doses may be prescribed for 3-6 months, such as nitrofurantoin or trimethoprim-sulfamethoxazole 1.
Imaging Studies
Imaging studies like renal ultrasound and voiding cystourethrogram (VCUG) are often recommended to identify vesicoureteral reflux or other structural abnormalities. The use of these imaging studies should be guided by the clinical presentation and risk factors for underlying anatomical abnormalities 1.
Management of Underlying Conditions
Children with dysfunctional voiding or other underlying conditions that may contribute to recurrent UTIs should receive targeted management, including urotherapy and bowel dysfunction management 1.
Key Considerations
- Recurrent UTIs can lead to kidney scarring if left untreated, potentially causing long-term kidney damage 1.
- Prompt diagnosis and appropriate management are crucial for protecting renal function in children.
- The management approach should be individualized based on the child's specific needs and risk factors.
From the Research
Diagnosis and Management of Recurrent UTI in Children
- The diagnosis and treatment of recurrent urinary tract infections (UTIs) in children is a controversial area, with different guidelines from the American Academy of Pediatrics, National Institute for Health and Clinical Excellence, and European Society of Paediatric Radiology 2, 3.
- Evaluating and treating bladder and bowel dysfunction are critical in reducing the risk of UTIs in children 4.
- The pathogenesis of Escherichia coli infections reveals that quiescent intracellular reservoirs may be antibiotic-protected sources of recurrent infections 4.
Risk Factors and Strategies for Intervention
- Recognizing the risk factors for recurrent UTIs and strategies for intervention is essential in managing the condition in children 4.
- Treatment of vesicoureteral reflux and antibiotic prophylaxis for prevention of recurrent UTI are areas of considerable debate 2.
Treatment Options
- Sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, and nalidixic acid are commonly used antimicrobials for UTIs, but their effectiveness may vary depending on the causative organism and local susceptibility patterns 5, 6.
- New antimicrobial agents, such as fosfomycin, pivmecillinam, and ceftazidime-avibactam, may be effective in treating UTIs caused by multidrug-resistant organisms, but their use should be guided by local susceptibility patterns and used wisely to avoid resistance development 6.