This is a quick review of the article found here
http://www.aafp.org/afp/2012/1115/p940.html
Am Fam Physician. 2012 Nov 15;86(10):940-946.
The American Academy of Pediatrics has updated its guidelines for treatment of urinary tract infections in children between two months and 2 years old. A positive culture is now defined as having at least 50,000 colony forming units per milliliter (instead of 100,000) Also, oral medication is as effective as parental treatment.
The other big changes from the 1999 guidelines is that now both urinalysis and culture should be performed. Also, performing a voiding cystourethrogram is no longer recommended after the first UTI. It is indicated, however, if the ultrasound shows hydronephrosis, scarring or obstruction. Otherwise it can be considered after recurrent infections.
According to the algorithm, if you have any belief that the patient has a UTI, (is between 2 months and 2 years old), and has a fever of at least 38C, you can go ahead and perform a urinalysis by catheterization or you can do a dipstick analysis. A urine collected by a bag is not reliable. If it's positive, you can start treatment, but send cultures first (or you are gonna hear it from everyone). If the culture and UA come back negative you can stop the treatment. You would also adjust the therapy according to the culture sensitivities. Once a UTI is confirmed you can do a renal bladder ultrasound. If it's the patient's second or more UTI, you can perform a voiding cystourethrograph.
In general it appears that there is a low threshold for checking urine in a patient with an infection of undetermined origin. Even if the child does not appear to be having a UTI, it should be assessed anyway.
The patient should be treated with antibiotics for 1 to 2 weeks.
As far as prophylaxis for current UTIs there has been shown to be no statistically significant benefit in this age group.
No comments:
Post a Comment