Urinary Tract Infection in Children

Prevention and Treatment

Prevention of Urinary Tract Infection

1. Increasing fluid intake dilutes urine and helps in flushing out bacteria from the urinary bladder and urinary tract.
2. Children should urinate every two to three hours. Holding urine in the bladder for a long period of time provides opportunity for bacteria to grow.
3. Keep genital area of children clean. Wipe child from front to back (not back to front) after toilet. This habit prevents bacteria in the anal region from spreading to the urethra.
4. Frequently change diapers to prevent prolonged contact of stool with the genital area.
5. Children should be made to wear only cotton undergarments to allow air circulation. Avoid tight-fitting pants and nylon underwear.
6. Avoid giving bubble baths.
7. For the uncircumcised boy, the foreskin of his penis should be washed regularly.
8. In children with VUR, recommend double or triple voiding (passing of urine) to prevent residual urine.
9. A low dose daily antibiotic for long-term as a preventive (prophylactic) measure is recommended for some children who are prone to chronic UTI.

Treatment of Urinary Tract Infection
General measures

All preventive measures for urinary tract infection should be followed.

• A child with UTI should be advised to drink more water. Sick hospitalized children need intravenous fluid therapy.
• Appropriate medications should be given for fever.
• Urinalysis and urine culture and sensitivity should be done after completion of treatment to ensure that infection is controlled adequately. Regular follow up with urine tests is necessary for all children to confirm that there is no recurrence of infection.
• Ultrasound and other appropriate investigations should be done for all children with UTI.

Specific treatment

• In children, UTI should be treated with antibiotics without delay to protect the developing kidneys.
• Urine culture should be sent before initiating treatment to identify causative bacteria and properly select antibiotics.
• A child needs hospitalization and intravenous antibiotics if he/ she has high grade fever, vomiting, severe flank pain and is unable to take medicine by mouth.
• Oral antibiotics may be given to children more than 3 to 6 months of age who are able to take oral medications.
• It is important that children complete a full course of prescribed antibiotics, even if the child no longer has symptoms of UTI.

Recurrent urinary tract infection

Children with recurrent, symptomatic UTI need additional tests such as ultrasound, VCUG and at times DMSA scan to identify the underlying cause. Three important treatable problems for recurrent UTI are VUR, the posterior urethral valves and kidney stones. According to the underlying cause, specific medical treatment followed by preventive measures and long term preventive antibiotics therapy is planned. In some children surgical treatment is planned jointly by the nephrologist and urologist.