Urinary infection in childhood

It is important to recognize because it may damage the growing kidney. In young children, symptoms are often non –specific but the child may pass cloudy or offensive urine. The possibility of urine sepsis should always be considered if a child fails to thrive or suffers unexplained pyrexia. Pain or screaming on micturition may occur. The older children may complain of loin pain and may develop urinary frequency and secondary enuresis.

Up to 50% of children with urinary infection have an underlying anatomical abnormality. The diagnosis is made from urine examination. Such children should be investigated for urinary tract abnormalities and to assess renal function.

Vesicoureteric reflux of urine is detectable in about 35% of children with recurrent urinary infection.

With urinary obstruction

Acute pyelonephritis associated with urinary retention. Acute pyelonephritis is a relatively uncommon complication of chronic urinary retention. Often the organisms are introduced during instrumentation. Patients who have a significant post micturition urinary residue should be given prophylactic antibiotics to cover transurethral procedure.

Treatment

   The treatment of acute pyelonephritis should be prompt, appropriate and prolonged. A full investigation to exclude underlying abnormalities in the urinary tract should be undertaken when the acute illness subsides.

   While awaiting the bacteriological report and results of sensitivity test, an antimicrobial with wide range of activity, such as amoxicillin or gentamicin, should be administered parenterally if necessary. If the urine is acidic, as it is in the common coliform infection, alkalization of urine by potassium citrate my help by inhibiting the growth of these organisms and relieving dysuria. Morphine like drugs is necessary when the pain is severe if non-steroidal anti-inflammatory agents are infective.  The patient should drink copiously; if this is not possible because of vomiting, an intravenous infusion should be set up.

   Most urinary infections acquired outside hospital are sensitive to relatively cheap agents such as trimethoprim and amoxicillin. Hospital acquire infections are much more likely to be resistant and more expensive second-line antibiotics may be needed. Gentamicin and Carbenicillin are suitable for combating infections with more resistant strains of Pseudomonas pyocyanea, Proteusspp. and Klebsiellaspp. Ciprofloxacin is particularly useful against Pseudomonasspp. In patient who do not have septicemia. Despite the efficacy of modern antibacterial drugs, recurrent infection is likely if there is an untreated underlying abnormality of the urinary tract such as stone, vesicoureteric reflux, fistula to the gastrointestinal tract or retention of urine.