Management

Urinary Tract Infection

Management: Urinary Tract Infection

• Diagnostic Tests• Curative– Specific– Supportive• Diet• Physical Activity• Prophylactic

• Preventive Health Care

Management: Diagnostic Tests

• Urinalysis• Ultrasound– rule out

hydronephrosis & renal or perirenal abscesses

– may show acute pyelonephritis

Management: Diagnostic Tests• Voiding Cystourethrogram (VCUG)

– indications:• All children younger than 5y/o• Any child with a febrile UTI• School aged girls who had 2 or more UTIs• Any male with UTI

– most common finding is vesicoureteral reflux

Management: Diagnostic Tests

• Dimercaptosuccinic Acid Scan (DMSA Scan)– functional & obstruction

anomaly– supports the diagnosis of

pyelonephritis with a finding of photopenia

– most sensitive & accurate study to demonstrate renal scarring

Mangement: Curative

• Specific– Antibiotics– Anti-pyretic– Analgesic

Mangement : Curative

• Trimethoprim-sulfamethoxazole (Co-trimoxazole)– folic acid synthesis inhibitor– given if culture & sensitivities are not yet available– effective against most strains of E.coli– dosing: 40 mkd SMX & 8 mkd TMP q 12 h– preparation: 200mg SMX & 40mg TMP/ 5ml – AE: Stevens-Johnson Syndrome, hepatitis,

cholestatic jaundice, megaloblastic anemia

Management : Curative

• Amoxicillin, Ampicillin– interferes with bacterial cell wall synthesis– also effective as TMP-SMX– dosing: 40 mkd q 8 h– preparation: 100mg/ml, 125mg/5ml, 250mg/5ml– AE: Diarrhea, indigestion, occassional rash either

urticarial or erythematous

Management : Curative

• Cephalosporins– 2nd or 3rd generation– Inhibits cell wall synthesis– dosing: 25-50 mkd q 6 h – preparation: 100mg/ml, 125mg/5ml, 250mg/5ml– AE: thrombophlebitis, diarrhea

Management : Curative

• Ciprofloxacin– inhibits DNA Gyrase and topoisomerase IV preventing

replication and repair– alternative agent for resistant microorganisms like

Pseudomonas– dosing: 20-30 mkd q 12 h– preparation: 100 mg, 250 mg, 500 mg, 750 mg,

1000 mg– AE: arthropathy, tendon damage, torsades de pointes

Management : Curative

• Gentamicin– inhibits bacterial protein synthesis– combined with ampicillin– dosing: 40 mkd q 6 h– preparation: 100mg/2.5ml, 200mg/5ml,

400mg/5ml– AE: ototoxicity, nephrotoxicity

Management : Curative

• Paracetamol– inhibits COX– anti-pyretic and analgesic– dosing: 10-15 mkd q 4 h– preparation: 125mg/5ml, 250mg/5ml– AE: ototoxicity, nephrotoxicity

Management : Curative

• Supportive– Diet• Increased oral fluid intake

– Physical Activity• Frequent voiding

– Prophylactic• Proper genital hygiene• Strict hand-washing• Avoid infrequent voiding

Management: Preventive Health Care

• At 3 years of age:– Vaccines• MMR 2• Varicela• Influenza

– Blood pressure monitoring– Nutrition counseling