The management of urinary tract infections in children without urinary tract abnormalities

Abstract

Although most urinary tract infections in children with normal urinary tract anatomy pose little threat to renal function, pyelonephritis, particularly in infants, may cause renal scarring when not diagnosed and treated promptly. For most children, however, the problems of urinary tract infection may be related to a biologic predisposition to recurrent infections and the bothersome clinical symptoms associated with them. In these children, infections should be diagnosed carefully and then treated for 3 days with appropriate antimicrobial agents. In children with frequently recurrent infections (more than two in 6 months), a prophylactic antimicrobial agent in the proper low dosage may be useful. Children bothered by infection-associated symptoms of bladder dysfunction with persistent incontinence may improve with treatment with anticholinergic drugs and/or bladder rehabilitation. There may also be a decrease in the rate of urinary tract infections with this treatment. When covert bacteriuria is found and bothersome symptoms are associated with it, symptoms should be treated. If recurrent covert bacteriuria is truly asymptomatic, however, not treating the infection may be the best option.