[Which treatment should children with recurrent urinary infections, without anatomical anomalies, receive?]

Abstract

Objective: To determine the best treatment for children with recurrent infection of the lower urinary tract and without anatomical abnormalities.

Methods: A clinical study was conducted on 150 children (30 boys and 120 girls), aged 4 to 36 months (mean 16), with recurrent urinary tract infections (UTI) and no radiological evidence of anatomical abnormalities. They were divided into three groups: group I was treated with a single nightly prophylactic dose of an antibiotic; group II received a single nightly dose of oxybutinin, or divided in 2-4 doses; group III received a single nightly prophylactic dose of an antibiotic and oxybutinin as in group II.

Results: There were more episodes of UTI in group I (44/50), more hospitalizations and problems of malnutrition, and a longer period of treatment was required. In group II, 14/50 children had episodes of UTI, their nutritional status improved and there were less hospitalizations. In group III, 3/50 children had episodes of UTI; they were the best responders and required a shorter duration of treatment.

Conclusions: Prophylactic therapy requires a longer period of treatment. The use of oxybutinin is an alternative modality in the treatment of these children. Combination therapy with a single nightly dose of an antibiotic and anticholinergic (oxybutinin) appears to be the best therapeutic modality for children with recurrent UTI and no anatomical abnormality.