Urinary tract infection in children treatment and symptoms
Urinary tract infection in children (urinary tract infections) is a frequent problem in the pediatric outpatient and inpatient departments. The frequency with which a occurs urinary tract infection child is 10-100 times higher in preterm infants than those born at term.
Urinary tract infection in a child is a serious and complex disease, because the urinary system of the baby (especially if the child is a newborn) is not fully developed, and more exposed to pathogens.
Infection in children occurs regardless of age: the symptoms of the disease can manifest itself in infants and toddler. In the first year of life the disease is more common in boys, after that age the situation changes dramatically, and the disease most often affects girls. After 7 years of age, signs of infections of the genitourinary system affect 8% of girls and 2.8% of boys, in half of the cases, the disease recurs within a year.
The causes of the disease include usually ascendent infection, which can occur when urinary catheterization or urological research. Escherichia coli (E. coli) is responsible for 80% of cases of urinary tract infections. Other causes include pathogens such as Enterobacteriaceae (e.g., Klebsiella, Enterococcus) or Candida Albicans. In the case of primary infection, with the identification of other bacterial strains except Escherichia coli, it is necessary to purposefully look for possible anomalies of the urinary tract! Most E. coli strains that cause acute pyelonephritis, bear on their surface a specific structure (called P-fimbriae) that allow them to contact the epithelial cells of the urinary tract. The kidney is responsible other, yet not identified factors.
Acute pyelonephritis associated symptoms such as fever and common inflammatory response of the body. Inflammation of the upper part of the urinary tract is prognostically more severe – it may result in renal scarring with subsequent increased risk of developing hypertension, bilateral renal lesions and chronic renal failure. The likelihood of these complications is higher in children under 2 years, especially in children with reflux vesicoureteral the highest level, severe obstructive uropathy and other congenital anomalies of the structure and function of the urinary tract.
Clinical manifestations of acute pyelonephritis is dependent on age – the younger the child, the less characteristic symptoms. In infants and young children, infection may take place under the picture of sepsis, or, conversely, is manifested only mild General symptoms such as fatigue, lethargy, unexplained temperature rises and gastrointestinal symptoms (e.g. vomiting). Especially in boys under 6 months and girls up to 1 year with long-term subfebrile and unexplained febrile States to consider the possibility of such diseases as urinary tract infection in children treatment which shall, after confirmation of diagnosis, carried out promptly.
The older children also infection of the upper urinary tract is held under a clinical picture of sepsis. Pyelonephritis should be considered for each child in the case of increasing of temperature to 39°C lasting > 2 days, which is unknown cause of fever. Pain in the lumbar region may be unilateral, but bilateral character, the most tangible may be in the groin area and lower abdomen. Possible and rare gastrointestinal symptoms (vomiting, diarrhea, abdominal pain).
Clinical manifestations of acute pyelonephritis are not always clear, and often the disease goes unrecognized under the picture of the General febrile state, the blame for which rests with the viral respiratory infection. In accordance with the observations of increased temperature every 15-20 baby is a manifestation of acute pyelonephritis. It is therefore recommended that whenever a feverish state and re-subfebrility in children, conduct a urine test to exclude urinary tract infection.
Unlike pyelonephritis, inflammation in the lower urinary tract infections (cystitis, urethritis) febrile reaction is fairly mild or completely absent, and the clinical picture is dominated by local characteristics. The typical symptoms such as burning and stinging when urinating, frequent urination, pressure or pain in the lower abdomen, becoming more frequent in later age from 3 years. In children who already do not urinate spontaneously, may occur secondary enuresis.
The required differentialdiagnostics, designed to exclude acute pyelonephritis, balanitis, vulvitis and dysfunction of the lower urinary tract. Dysuria without fever, it is most likely that vulvitis in girls or balanitis in boys. In sexually active adolescents clinical signs of cystitis with sterile leukocyturia and urine (or with insignificant bacteriuria) can indicate chlamydia or mycoplasmal infection. Pyuria with sterile urine (or with insignificant bacteriuria) can be a symptom of chronic trigonitis.
Treatment of acute pyelonephritis
The main risk factor for development of renal scarring is delayed treatment of pyelonephritis (in addition to the young age of the patient)! Therefore, to treat the disease should start within 24 hours clinical suspected urinary tract infections. Assigned to monotherapy with bactericidal antibiotics, which are selected in accordance with the current state of information about the most common pathogens of bacterial resistance in the country, and specifically in certain areas. Considering about 50% resistance of E. coli to (not reinforced) aminopenicillin are suitable only antibiotics that are resistant to betalactamase (to include protected aminopenicillins or cephalosporins of the III generation). The use of fluoroquinolones in Pediatrics is limited because of insufficient clinical experience and the risk of possible damage to growing cartilage of joints. In infants receiving quinolone is recommended only for severe disease in older children and adolescents antibiotics of this group can be used, but not as drugs of first choice.
The treatment of pyelonephritis usually lasts 10 to 14 days. In practice, the proven efficiency of sequential antibiotic therapy after 3-5 days after initial parenteral treatment when the patient's condition stabiliziruemost, transition to oral antibiotics.
The initial parenteral phase of treatment, particularly important in infants and young children, whose oral therapy in the acute phase of the disease could be problematic (lack of appetite, vomiting, etc.). Excellent results were shown in sequential parenteral (or, if possible, orally), a cephalosporin (e.g., Cefixime, followed by the introduction Cefizox, Cefotaxime, or Ceftriaxone) or intravenous aminoglycosides antibiotic, with follow-up therapy with oral antibiotics (protected aminopenicillins or cephalosporins). In children under 6 years of antibiotic therapy may continue for chemotherapeutic drugs (Cotrimoxazole or Trimethoprim) in one evening dose over 2 weeks.
Clinical signs (fever, vomiting, etc.) can be reduce with appropriate treatment, usually within 48-72 hours, this time is a urine culture is usually sterile. Otherwise, the appropriateness of antibiotic therapy after 48 hours is revalued based on the results of urine culture and identify possible complications, such as obstruction of the urinary tract, abscesses of the kidneys, etc.
In addition to antibiotic therapy, as appropriate, are administered drugs anti-inflammatory action and antipyretic (Ibuprofen, Paracetamol, Nurofen), but in young children and Diazepam to prevent febrile seizures. In the dehydration of newborns and infants in preference to Paracetamol because of the risk of acute renal failure after administration of Ibuprofen.
The main measure is a sufficient intake of fluids, rest and warmth. A child with urinary tract infection should not have thirst. The increased fluid intake increases the urine output, which washed out the products of inflammation and, consequently, limit the spread of invasive bacteria. Consumed beverages should be warm or at room temperature, in any case not cold. Suitable herbal teas, unacceptable – carbonated beverages. Makes no sense to force the child to drink, that he was not tasty (for example, urological tea). As for the food, in this case special measures are needed. Is not irritating, age-appropriate food, which also should not be too salt. Do older children with urinary tract infections is necessary to ensure regular urination. Dietary measures should also account for possible constipation.
Treatment of acute cystitis
Treatment of acute cystitis is initially empirical, in the absence of the effectiveness of therapy varies in accordance with the sensitivity of bacteria in a urine sample collected before treatment with antibiotics. We also introduce chemotherapeutic drugs (Cotrimoxazole or Trimethoprim) or oral cephalosporins. Opinions on the duration of antibiotic therapy for infections of the lower urinary tract different. Shorter periods of treatment in adults is justified fewer side effects, less risk of resistant strains, as well as economic indicators. Not to mention the fact that together with antibacterial therapy in women increases the risk of gynecological fungal infections. Atchildren are given preference over short but effective treatment, which should last for 3-5 days. It was shown that such short-term therapy is as effective as standard treatment, continuing from 7 to 14 days. In children disposable antibacterial therapy of urinary tract infections is not appropriate.
At the first signs of urinary tract infections in a child should be referred to a specialist for diagnosis. In the case of confirmation of the presence of the disease, should immediately begin the appropriate treatment, otherwise, there is a high risk of complications in the form of kidney damage and development of their insufficiency.