Management of urinary tract infection.

The urinary tract is a common site for bacterial infection in childhood. Population screening for bacteriuria has revealed a slight male preponderance in the neonatal period, but thereafter it is more prevalent in girls, becoming as much as 50 times more common by the age of 5 years. Follow up of asymptomatic bacteriuria in schoolgirls has failed to show any convincing evidence that its discovery by screening can materially alter the outcome.1 In preschool children the difficulties encountered in obtaining uncontaminated urine samples, together with the low acceptance rate, militate against cost effectiveness.2 Moreover, most renal scars observed are already present at initial investigation,3 and their prevalence in infants is, disappointingly, as high as it is in older children.4 The practising paediatrician should therefore be concerned mainly with the management of symptomatic urinary tract infection (UTI), and the two basic aims of treatment are the relief of symptoms and the prevention, or at least limitation, of damage to the renal parenchyma. Experimental work in refluxing piglets has shown that the scarring process can be initiated within one week of introducing pathogenic bacteria into the bladder,5 and there is good reason to believe that this may apply to children. Treatment with antibiotics of first infections in young children should therefore be regarded as a matter of urgency. The wide range of suitable antibiotics now available has made treatment a comparatively simple matter. Management, however, is more than just eradicating infection; it is also concerned with diagnostic reliability, alleviation of associated symptoms not directly due to bacteriuria, assessment of underlying structural abnormalities and the potential risk of future upper tract damage, and careful follow up of selected at risk patients throughout the growth period.