Postgraduate Medicine

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Urinary tract infection in children Gunnar B. Stickler To cite this article: Gunnar B. Stickler (1979) Urinary tract infection in children, Postgraduate Medicine, 66:4, 159-165, DOI: 10.1080/00325481.1979.11715278 To link to this article:

Published online: 07 Jul 2016.

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Date: 19 August 2017, At: 10:14

Urinary tract infection in children Diagnosis and treatment

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Gunnar B. Stickler, MD

Consider Which urine collection method a/lows for the most accurate diagnosis of urinary tract infection? What is the best screening method for urinary tract infection? For treatment of uncomplicated urinary tract infection, what agent is recommended? Why?

Urinary tract infection in children is overdiagnosed because of poor methods of urine sample coUection. Routine urinalysis is of little help, and more often than not results are misleading. This discussion suggests ways to avoid such pitfaUs in diagnosis and gives treatment recommendations for single and recurrent attacks. Urinary tract infection (UTI) in children is second in frequency only to upper respiratory tract infection. Yet, UTI is at times overdiagnosed. Improper usage of terms bas led many parents to worry about kidney infection rather than about UTI. The term "kidney infection" may imply a disease process leading to more and more renal damage, and the specter of a kidney transplant may be in parents' minds. In patients with a normal urinary tract, progression of UTI to renal failure is indeed rare, if it occurs at ali.' Attempts are increasingly being made to localize the site of infections within the urinary tract, and in time there may be not only a theoretical subdivision of such infections but also practical applications of the categorization. The term "bacterial nephritis" should be reserved for bacterial infection of the kidney usually caused by hematogenous spread of an organism, which is a rare form of true kidney infection. "Pyelitis" implies inflammation of the renal collecting system, and the term "pyelonephritis" is properly .used on! y if there is invasion of the renal parenchyma. Cystitis occurs much more frequently. Many pa-


tients with urinary frequency and dysuria may have urethritis and the so-called urethral syndrome, or sham syndrome. Incidence Many reviews regarding UTI in children have been published.2•5 Data collected by Kunin 3 indicate that about 1.5 million girls in the United States have bad significant bacteriuria at !east once before reaching the age of 18. Various prevalence studies suggest that on any given day between 350,000 and 700,000 girls and about 10,000 boys have bacteriuria. Prevalence in boys is 0.03% and in girls, between 0.8% and 2.0%. In newborns, however, the incidence ranges from 0.1% to 1.4%, as found in studies quoted by Abbott. 6 In this age group boys are affected more frequently than girls. Symptoms Symptoms suggesting UTI include frequent voiding, pain on urination, urgency, straining on voiding, an offensive odor to the urine, and recurrence of enuresis. Fever with chills, pain in the abdomen or flank, and intestinal symptoms such as vomiting or diarrhea may suggest continued


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ln newborns, bacteriuria is more common in boys than in girls; in older children, it is much more prevalent in girls.

labie 1. Methoda for proper collection of urine umples for bacteriologie dlegnosls* of collection

Relleblllty of specimen Patients

Urinary tract infection in children: diagnosis and treatment.

Postgraduate Medicine ISSN: 0032-5481 (Print) 1941-9260 (Online) Journal homepage: Urinary tract infection in...
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