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UTIs in Children

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by

Mary James

on 10 May 2012

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Transcript of UTIs in Children

UTI's in Children abd pain
fevers
nausea/vomiting
jaundice (neonates) Pyelonephritis Cystitis "classic symptoms" 3 Varieties Asymptomatic Bactiuria + culture only Incidence/Prevalence in general... GIRLS > BOYS Tight Clothing Bubble Baths Risk Factors Female
Wiping back to front
VUR
Uncircumcised
Obstruction Constipation Toilet Training Sitting in Buckets Diagnosis The Bag: A last Resort Clean Catch >100,000 (>10,000 in boys) Cath >100,000 (>10,000 in boys) Suprapubic Any ????????? treatment < 1 month Amp + Gent 1-3 months Amp + Cefotaxime > 3 months Cefotaxime
or
Ceftriaxone Older Children
needing IV 3rd or 4th generation cephalosporins or aminoglycosides PO aMOXIL OR BACTRIM CEFIXIME (OR OTHER 3RD GEN CEPHALOSPORIN}
if resistence duration 5 days if: >2, normal urinary tract, afebrile and no previous UTI Otherwise 10 - 14* *unless pseudomonas, then 21 follow up No need to repeat the culture Kids who need further testing: * Boys with 1st uti
* girls < 3
* Febrile UTI
* Recurrent UTI
* Unusual organism
* con't symptoms >72 hrs
* family history renal ultrasound vcug if abnormal... DMSA/RADIONUCLEOTIDE CYSTOGRAPHY pROPHYLAXIS? aMOXIL IF < 2 MONTHS
tmp/smx OR NITROFURANTOIN Use it while waiting for studies


Once grade known:
* check urine cultures every 4 months
* repeat VCUG in 12-18 months the end Before Whose Urine should we test? Now Children 2 mos to 2 yrs with unexplained fever selective urine testing
based on the prior probability of UTI Probability of UTI Among Febrile Infant Girls28 and Infant Boys30 According to Number of Findings Present. aProbability of UTI exceeds 1% even with no risk factors other than being uncircumcised. Pediatrics 2011;128:595-610 ©2011 by American Academy of Pediatrics Renal/bladder ultrasound after first febrile UTI to rule out anatomic abnormalities (particularly obstruction) that might warrant further evaluation? New Imaging Guidelines not necessarily VCUG after first febrile UTI? no (at least not routinely) no longer recommended Back in the Day 2012 1999 Proph. ABX >> Surgery no need for proph abx ureteral transplantation A History
of
treatment of vesicoureteral reflux (VUR) however... the AAP still recommends VCUG
after 2nd UTI
based on
increasing likelihood of detecting higher grades of reflux
in children with recurrent UTIs
and
the belief that detecting grade V reflux is beneficial Recommends that "parents or guardians of children with confirmed UTI “seek prompt (ideally within 48 hours) medical evaluation for future febrile illnesses to ensure that recurrent infections can be detected and treated promptly.” new guideline: no prophylaxis 2012 1999 do not decrease incidence of symptomatic UTIs
absolute risk reduction was 6%
no reduction in:
hospitalizations for UTI
incidence of renal scarring
regardless of whether VUR present Special Thanks
Dr. Melanie Semelka
Dr. T.J. Maroon Why Do we Worry? Renal Parenchemal Defects HTN
Chronic Renal Failure
Toxemia in Pregnancy DIAGNOSIS IN OLDER CHILDREN +leukocyte esterase or nitrite on dipstick

pyuria of at least 10 wbcs/hpf

bacteriuria on microscopy 85% General Principles of Treatment Amoxicillin
less acceptable 2/2 increased rates of e.coli resistance

Trimethoprim/sulfamethoxazole
studies show higher rates of cure

Other options
cephalosporins, augmentin Oral Antibiotics Good evidence to suggest oral is as effective as IV "Practical Considerations" If IV antibiotics are needed... Change Antibiotics based on cultures? "An empty rectum is a happy bladder" - Dr. Whitney Snowman Official
Guidelines Parents or guardians of children with confirmed UTI should “seek prompt (ideally within 48 hours) medical evaluation for future febrile illnesses to ensure that recurrent infections can be detected and treated promptly.”
Who needs imaging? Before... SUMMARY New Recommendations Evaluate febrile 2-24 month olds based on probability (see chart)

PO just as effective as IV in well appearing febrile children who can take PO

Very few children need imaging

Prophylactic antibiotics no longer recommended

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