18LA1MLn1

Infants younger than 8 weeks w|th a febr||e U1I

1he dlagnosls ln lnfanLs younger Lhan age 8 weeks wlLh a febrlle u1l ls usually based on fever
and on poslLlve resulLs from a urlne speclmen obLalned by caLheLerlzaLlon lnfanLs wlLh such
flndlngs are usually hosplLallzed and recelve parenLeral anLlbloLlc Lherapy Powever cllnlcal
[udgmenL may lndlcaLe LhaL home LreaLmenL ls approprlaLe arenLeral anLlbloLlcs may be used
wlLh dally followup unLll Lhe paLlenL ls afebrlle for 24 hours CompleLe 1014 days of Lherapy
wlLh an oral anLlbloLlc LhaL ls acLlve agalnsL Lhe lnfecLlng bacLerla
A reLrospecLlve revlew of more Lhan 1300 bables aged 2960 days wlLh fever and culLure
proven u1ls were analyzed for hlghrlsk crlLerla on presenLaLlon 1hose lnfanLs wlLhouL a hlgh
rlsk pasL medlcal hlsLory and noL cllnlcally lll on presenLaLlon Lo an Lu along wlLh lowrlsk
laboraLory values were aL low rlsk overall for bacLeremla and serlous adverse evenLs such as
menlnglLls or need for lCu supporL ConslderaLlon for brlefer hosplLallzaLlon and close
ouLpaLlenL managemenL can be made for Lhls subgroup of young lnfanLs aged 2960 days wlLh
u1ls lf Lhe medlcal hlsLory ls concernlng Lhen Lhese lnfanLs should be LreaLed as younger
lnfanLs aged 028 days


A secondary analysls of a mulLlcenLer reLrospecLlve revlew found LhaL sLerlle cerebrosplnal fluld
pleocyLosls occurred ln 214 (18) of 1190 febrlle young lnfanLs (aged 2960 d) sLudled wlLh
culLureproven u1ls 1hese paLlenLs are aL very low rlsk for adverse evenLs and may be
consldered for shorLer courses of lnLravenous anLlbloLlcs


1ab|e 3 Ant|b|ot|c Agents for arentera| 1reatment of a Ur|nary 1ract Infect|on
Drug Dosage and koute Comment
CefLrlaxone O 3073 mg/kg/d lv/lM as a slngle
dose or dlvlded q12h
O uo noL use ln lnfanLs 6 wk of
age parenLeral anLlbloLlc wlLh
long halfllfe may dlsplace
blllrubln from albumln
CefoLaxlme O 130 mg/kg/d lv/lM dlvlded q68h O afe Lo use ln lnfanLs 6 wk of
age used wlLh amplclllln ln
lnfanLs aged 28 wk
Amplclllln O 100 mg/kg/d lv/lM dlvlded q8h O used wlLh genLamlcln ln neonaLes
2 wk of age for enLerococcl and
paLlenLs allerglc Lo cephalosporlns
CenLamlcln O 1erm neonaLes 7 d 333
mg/kg/dose lv q24h

lnfanLs and chlldren 3 y 23
mg/kg/dose lv q8h or slngle dally
O MonlLor blood levels and kldney
funcLlon lf Lherapy exLends 48 h
doslng wlLh normal renal
funcLlon of 373 mg/kg/dose lv
q24h

Chlldren 3 y 223 mg/kg/dose
lv q8h or slngle dally doslng wlLh
normal renal funcLlon of 373
mg/kg/dose lv q24h
Infants and ch||dren aged 2 months to 2 years w|th a f|rst febr||e U1I
1he Amerlcan Academy of edlaLrlcs lssued Cllnlcal racLlce Culdellnes regardlng Lhe dlagnosls
and managemenL of lnlLlal u1l ln febrlle lnfanLs and chlldren aged 224 monLhs summarlzed as
follow
O AfLer 714 days of anLlmlcroblal LreaLmenL close cllnlcal followup monlLorlng should be
malnLalned Lo permlL prompL dlagnosls and LreaLmenL of recurrenL lnfecLlons
O ulLrasonography of Lhe kldneys and bladder should be performed Lo deLecL anaLomlc
abnormallLles
O ecause daLa do noL supporL Lhe use of anLlmlcroblal prophylaxls Lo prevenL febrlle
recurrenL u1l ln lnfanLs wlLh no veslcoureLeral reflux (vu8) or wlLh grade l Lo lv vu8 a
voldlng cysLoureLhrography (vCuC) ls noL recommended rouLlnely afLer Lhe flrsL u1l
O vCuC ls lndlcaLed lf renal and bladder ulLrasonography reveals hydronephrosls scarrlng
or oLher flndlngs LhaL suggesL elLher hlghgrade vu8 or obsLrucLlve uropaLhy
O vCuC should be performed lf Lhere ls a recurrence of a febrlle u1l even lf prevlous
ulLrasound examlnaLlon was unremarkable
lf cllnlcal flndlngs lndlcaLe LhaL lmmedlaLe anLlbloLlc Lherapy ls lndlcaLed a urlne speclmen for
urlnalysls and culLure should be obLalned by means of suprapublc asplraLlon or caLheLerlzaLlon
before LreaLmenL ls sLarLed
ome evldence suggesLs no slgnlflcanL dlfferences ln efflcacy beLween lv anLlbloLlc Lherapy
glven for 3 days followed by oral Lherapy for anoLher 11 days and 14 days of oral Lherapy 1hese
daLa are based on a randomlzed conLrol Lrlal of 306 chlldren aged 124 monLhs LhaL compared
oral ceflxlme for 14 days wlLh lv cefoLaxlme for 3 days followed by oral ceflxlme for 11 days no
noLable dlfferences were observed ln shorL or longLerm ouLcomes (eg cllnlcal response
relnfecLlon renal scars aL 6 mo)
1hese daLa led Lo Lhe recommendaLlon LhaL chlldren wlLh a febrlle u1l should recelve oral
LreaLmenL wlLh a second or LhlrdgeneraLlon cephalosporln amoxlclllln clavulanaLe or
sulfameLhoxazoleLrlmeLhoprlm (MZ1M)
1ab|e 4 Ant|b|ot|c Agents for the Cra| 1reatment of Ur|nary 1ract Infect|on
Ant|bacter|a| Agent Da||y Dosage
ulflsoxazole 120130 mg/kg dlvlded q46h
ulfameLhoxazole and LrlmeLhoprlm 612 mg/kg 1M 3060 mg/kg MZ dlvlded q12h
Amoxlclllln and clavulanlc acld 2040 mg/kg dlvlded q8h
Cephalexln 2030 mg/kg dlvlded q6h
Ceflxlme 8 mg/kg dlvlded q1224h
Cefpodoxlme 10 mg/kg dlvlded q12h
nlLrofuranLoln
*
37 mg/kg dlvlded q6h

*nlLrofuranLoln may be used Lo LreaL lower u1ls Powever because of lLs llmlLed Llssue
peneLraLlon nlLrofuranLoln ls noL sulLable for Lhe LreaLmenL of kldney lnfecLlon
A chlld LreaLed wlLh oral anLlbloLlcs should noL be acuLely lll or Loxlc and he or she should noL
have perslsLenL vomlLlng or moderaLe Lo severe dehydraLlon ually followup and good
compllance ls essenLlal wlLh Lhls managemenL
1he charL below deLalls a LreaLmenL approach for febrlle lnfanLs younger Lhan 3 monLhs wlLh a
LemperaLure of more Lhan 38C
Inpat|ent treatment of ch||dren w|th comp||cated pye|onephr|t|s
rovlde approprlaLe parenLeral flulds usually aL 113 Llmes Lhe usual malnLenance raLe
arenLeral LreaLmenL wlLh a LhlrdgeneraLlon cephalosporln such as cefLrlaxone or cefoLaxlme
ls approprlaLe lnlLlal emplrlc coverage for a compllcaLed u1l and pyelonephrlLls Lo cover for
amplcllllnreslsLanL gramnegaLlve paLhogens Add amplclllln lf gramposlLlve coccl are presenL
ln Lhe urlnary sedlmenL or lf no organlsms are observed CenLamlcln ls an alLernaLlve for Lerm
lnfanLs older Lhan 7 days for older chlldren and for adolescenLs who are allerglc Lo
cephalosporlns MonlLor renal funcLlon and blood amlnoglycoslde levels lf Lhls medlcaLlon ls
requlred for more Lhan 48 hours
8esulLs of urlne culLure and senslLlvlLy sLudles are usually avallable wlLhln 48 hours lf Lhe
paLhogen ls senslLlve Lo Lhe anLlbloLlc used and lf Lhe chlld ls lmprovlng conLlnue LreaLmenL
wlLh Lhe parenLeral rouLe unLll Lhe chlld ls afebrlle for 2436 hours An oral anLlbloLlc LhaL ls
effecLlve agalnsL Lhe lnfecLlng organlsm may Lhen be subsLlLuLed for parenLeral Lherapy
1he hosplLallzed paLlenL ls usually ready Lo go home afLer 4872 hours ConLlnue LherapeuLlc
doses of anLlbloLlcs for a LoLal of 1014 days of anLlbloLlc Lherapy AnLlbacLerlal Lherapy should
be glven Lo prevenL relnfecLlon and should conLlnue aL leasL unLll a vCuC ls obLalned (lf one ls
Lo be obLalned)
1ab|e S Ant|b|ot|c Agents to revent ke|nfect|on
Agent S|ng|e Da||y Dose
nlLrofuranLoln* 12 mg/kg C
ulfameLhoxazole and LrlmeLhoprlm* 12 mg/kg 1M 310 mg/kg MZ C
1rlmeLhoprlm 12 mg/kg C

*uo noL use nlLrofuranLoln or sulfa drugs ln lnfanLs younger Lhan age 6 weeks 8educed doses
of an oral flrsLgeneraLlon cephalosporln such as cephalexln aL 10 mg/kg may be used unLll Lhe
chlld reaches age 6 weeks Amplclllln or amoxlclllln are noL recommended because of Lhe hlgh
lncldence of reslsLanL n
Ch||dren w|th cyst|t|s
Chlldren wlLh cysLlLls usually do noL requlre speclal medlcal care oLher Lhan approprlaLe
anLlbloLlc Lherapy and sympLomaLlc LreaLmenL lf voldlng sympLoms are marked AnLlbloLlc
Lherapy ls sLarLed on Lhe basls of Lhe pracLlLloners appralsal of Lhe paLlenLs cllnlcal hlsLory and
urlnalysls resulLs before Lhe dlagnosls ls documenLed
ysLemaLlc revlews of LreaLmenLs for cysLlLls ln chlldren showed no dlfference ln Lhe efflcacy
wlLh 714 days of Lherapy compared wlLh 24 days lngledose or slngleday Lherapy ls noL
recommended ln chlldren wlLh cysLlLls
ympLomaLlc rellef for dysurla conslsLs of lncreaslng fluld lnLake Lo enhance urlne dlluLlon and
ouLpuL aceLamlnophen and nonsLeroldal anLllnflammaLory drugs lf voldlng sympLoms are
severe and perslsLenL add phenazopyrldlne hydrochlorlde (yrldlum) uo noL admlnlsLer
phenazopyrldlne hydrochlorlde for longer Lhan 48 hours because of Lhe rlsk of
meLhemogloblnemla hemolyLlc anemla and oLher adverse reacLlons
lLLlng ln a Lub of warm waLer for 2030 mlnuLes 34 Llmes a day ofLen affords sympLomaLlc
rellef aLlenLs wlLh severe voldlng dlscomforL may obLaln rellef by uslng an approprlaLely slzed
recLal supposlLory of belladonna and oplum lnform Lhe paLlenL Lo use Lhese supposlLorles no
more Lhan 4 Llmes a day and for no longer Lhan 2 days
A 4day course of an oral anLlbloLlc agenL ls recommended for Lhe LreaLmenL of cysLlLls lf Lhe
cllnlcal response ls noL saLlsfacLory afLer 23 days alLer Lherapy on Lhe basls of anLlbloLlc
suscepLlblllLy

Avold unnecessary use of anLlbloLlcs for upper resplraLory lnfecLlons and oLlLls medla
AnLlbloLlcs can alLer Cl and perlureLhral flora and compromlse naLural defenses agalnsL
colonlzaLlon by paLhogenlc agenLs
1reaL voldlng dysfuncLlon especlally when lL ls assoclaLed wlLh posLurlng whlch can lead Lo
ureLhroveslcal reflux and recurrence of u1ls Conslder clrcumclslon of male neonaLes
Cne sLudy lnvesLlgaLed Lhe effecL of dally cranberry [ulce ln female chlldren wlLh recurrenL u1ls
and concluded LhaL dally consumpLlon of concenLraLed cranberry [ulce can slgnlflcanLly prevenL
Lhe recurrence of sympLomaLlc u1ls


8LAC1lCn
urlnary 1racL lnfecLlons has a loL of sympLoms besldes frequenL voldlng Lhese lncludes Wlplng
from back (near Lhe anus) Lo fronL afLer golng Lo Lhe baLhroom ln glrls Lhls can brlng bacLerla Lo Lhe
openlng where Lhe urlne comes ouL veslcoureLeral reflux a condlLlon LhaL can brlng urlne back Lo Lhe
kldneys blrLh defecLs ln urlnary sysLem and also braln or nervous sysLem lllnesses (menlngocele splnal
cord ln[ury and hydrocephalus) u1ls can only be LreaLed by AnLlbloLlcs by veln or orally LreaLmenL can
be longer as 6 monLhs Lo 2 years especlally when u1ls come back afLer LreaLmenL from Lhe hosplLal
All ln all Lo prevenL ourselves Lo have u1ls we musL know LhaL u1ls came from Lhe bacLerla LhaL
can conLamlnaLe our urlnary LracL so we musL lncrease our fluld lnLake proper dleL and always vold
when needed so LhaL bacLerla won'L grow ln our urlnary LracL lurLhermore u1ls can be severe so
whlle early LreaLlng lL soon can prevenL furLher conLamlnaLlon