32 Ö. Aydogdu and C. Radmayr

8.In case of sensitivity or allergy to cephalosporins, aztreonam or gentamicin may be preferred.

9.Parenteral therapy should be continued for 24–36 h. After this period if the child becomes afebrile and able to take fluids, oral antibiotic treatment as aforementioned may be administered. In case of severe UTIs,

oral antibiotic treatment should be continued 10–14 days.

3.12  Prophylaxis and Prevention

1.Prophylactic antibiotics may reduce the risk of recurrent UTIs.

2.In case of increased risk of pyelonephritis (VUR, recurrent UTI) and until the diagnostic studies are completed antibiotic prophylaxis should be given.19, 23

3.Most preferred and effective agents are TMP, cephalexin, nitrofurantoin and cefaclor.

4.Cranberry juice and related products may be administered for prevention, but the evidence base is too limited to support the use of cranberry juice alone.

5.Breastfeeding has been shown to offer significant protection against UTIs by the protective factors such as lactoferrin and oligosaccharides in human milk.19, 23

6.Underlying conditions which increase the risk of a potential UTI such as voiding dysfunction and constipation should be treated properly.11, 12

7.Significant abnormalities in the urinary tract (e.g., VUR, obstruction), should be corrected with appropriate urological intervention.

8.Boys with underlying urinary system disorders such as posterior urethral valve and VUR may benefit from neonatal circumcision. However this remains controversial.6, 7, 10

Chapter 3.  Urinary Tract Infection: Europe

33

References

1.Qigley R. Diagnosis of urinary tract infections in children. Curr Opin Pediatr. 2009;21:194-198.

2.Riccabona M. Urinary tract infections in children. Curr Opin Urol. 2003;13:59-62.

3.Foxman B. Epidemiology of urinary infections: incidence, morbidity, and economic costs. Am J Med. 2002;113(Suppl 1A):5S-135S.

4.Jodal U. The natural history of bacteriuria in childhood. Infect Dis Clin North Am. 1987;1(4):713-729.

5.Ma JF, Shortliffe LM. Urinary tract infection in children: Etiology and epidemiology. Urol Clin North Am. 2004;31(3):517-526.

6.Craig JC, Knight JF, Sureshkuman P, Mantz E, Roy LP. Effect of circumcision on incidence of urinary tract infection in preschool boys. J Pediatr. 1996;128(1):23-27.

7.To T, Agha M, Dick PT, Feldman W. Cohort study on circumcision of newborn boys and subsequent risk of urinary-tract infection. Lancet. 1998;352(9143):1813-1816.

8.Shapiro ED. Infections of the urinary tract. Pediatr Infect Dis J. 1992;11(2):165-168.

9.Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Pediatrics. 1999;103(4):e39.

10.Fussell EN, Kaack MB, Cherry R, Roberts JA. Adherence of bacteria to human foreskins. J Urol. 1988;140(5):997-1001.

11.Wan J, Kaplinsky R, Greenfield S.Toilet habits of children evaluated for urinary tract infection. J Urol. 1995;154(2):797-799.

12.Schulman SL. Voiding dysfunction in children. Urol Clin North Am. 2004;31(3):481-490.

13.Abrahamsson K, Hansson S, Jodal U, Lincoln K. Staphylococcus saprophyticus urinary tract infections in children. Eur J Pediatr. 1993;152(1):69-71.

14.Mori R, Lakhanpaul M, Verrier-Jones K. Diagnosis and management of urinary tract infection in children: summary of NICE guidance. BMJ. 2007;335:395-397.

15.Struthers S, Scanlon J, Parker K, Goddard J, Hallett R. Parental reporting of smelly urine and urinary tract infection. Arch Dis Child. 2003;88:250-252.

16.Alper BS, Curry SH. Urinary tract infection in children. Am Fam Physician. 2005;72(12):2483-2488.

17.Lin DS, Huang SH, Lin CC, et al. Urinary tract infection in febrile infants younger than eight weeks of Age. Pediatrics. 2000;105(2):E20.

34Ö. Aydogdu and C. Radmayr

18.Luk WH, Woo YH, Au-Yeung AWS, Chan JCS. Imaging in pediatric urinary tract infection: A 9-year local experience. AJR Am J Roentgenol. 2009;192:1253-1260.

19.Zorc JJ, Kiddoo DA, Shaw KN. Diagnosis and management of pediatric urinary tract infections. Clin Microbiol Rev. 2005;18:417-422.

20.Long E,Vince J. Evidence behind the WHO guidelines: hospital care for children: what are appropriate methods of urine collection in UTI? J Trop Pediatr. 2007;53:221-224.

21.Cavagnaro F. Urinary tract infection in childhood. Rev Chilena Infectol. 2005;22(2):161-168.

22.Whiting P,Westwood M,Watt I, et al. Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection in children under five years: a systematic review. BMC Pediatr. 2005;5:4.

23.Watson AR. Pediatric urinary tract infection. EAU Update Ser. 2004;2:94-100.

24.Stamm WE. Measurement of pyuria and its relation to bacteriuria. Am J Med. 1983;75(1B):53-58.

25.Hoberman A, Chao HP, Keller DM, Hickey R, Davis HW, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr. 1993;123(1):17-23.

26.De Sadeleer C, De Boe V, Keuppens F, Desprechins B, Verboven M, Piepsz A. How good is technetium-99m mercaptoacetyltriglycine indirect cystography? Eur J Nucl Med. 1994;21(3):223-227.

27.Kass EJ, Kernen KM, Carey JM. Paediatric urinary tract infection and the necessity of complete urological imaging. BJU Int. 2000;86(1):94-96.

28.Mabant S, To T, Friedman J. Timing of voiding cystourethrogram in the investigation of urinary tract infections in children. J Pediatr. 2001;139:568-571.

29.Ransley PG, Risdon RA. Renal papillary morphology in infants and young children. Urol Res. 1975;3(3):111-113.

Chapter 4

Urinary Tract Infection:

Australasia

Naeem Samnakay and Andrew Barker

Key Points

››Always check the antenatal history in a child with a UTI.

››A renal USS must be obtained in all children after an initial UTI. It will not exclude VUR.

››An MCU is an important test that should be done selectively looking for VUR, bladder anomalies or posterior urethral valves. It is performed after the first UTI in those with an abnormal USS, after UTI requiring IV antibiotics or if there is a strong family history of VUR; or after a second UTI in a child who had a previous normal USS. A male child post-UTI with a history or USS suspicious for posterior urethral valves should have an MCU.

››VUR can be treated surgically and surgical manage­ ment has been shown to significantly reduce the risk of febrile UTIs in children with VUR compared to medical management alone.

P.P. Godbole et al. (eds.), Guide to Pediatric Urology and

35

Surgery in Clinical Practice, DOI: 10.1007/978-1-84996-366-4_4,

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