10. Treatment 6-12mg/kg & 30-60mg/kg In 2 doses Trimethoprim/ Sulfamethoxazole (Bactrim) 120-150mg/kg in 4 doses Sulfisoxazole (Gantrisin) 15-30mg/kg in 2 doses Loracarbef (Lorabid) 50-100mg/kg in 4 doses Cephalexin (Keflex) 30mg/kg in 2 doses Cefprozil (Cefzil) 10mg/kg in 2 doses Cefpodoxime (Vantin) 8mg/kg in 2 doses Cefixime (Suprax) 20-40mg/kg in 3 doses Amoxicillin* Daily Dosage Antibiotic
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13. Prevention 2mg/kg & 10mg/kg nightly or 5mg/kg & 25mg/kg 2x/week Trimethoprim/ sulfamethoxazole (Bactrim) 10-20mg/kg in 2 doses Sulfisoxazole (Gantrisin) 1-2mg/kg once per day Nitrofurantoin (Macrobid) 30mg/kg in 2 doses Nalidixic acid (NegGram) 75mg/kg in 2 doses Methenamine mandelate (Mandelamine) Daily Dosage Antibiotic
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Editor's Notes
Other organisms: proteus, klebsiella, enterococcus, coag neg staph
Dilute urine may produce false negative results U/A does not allow one to make the dx because too many false positives
Michael M, et al. Short versus standard duration oral antibiotic therapy for acute UTI in children. Cochrane Database Syst Rev 2004;(4)CD003966. Short vs long- 2004 cochrane review- 2-4 days appears to be as effective as 7-14 days in eradicating lower UTI in children;
Amox is recommended first line in infants < 2 months old
Williams GJ, et al. Long-term antibiotics for preventing recurrent UTI in children. Cochrane Database Syst Rev. 2004;(4):CD001534. Prophylactic abx use- 2004 Cochrane review and 2000 systematic review looked at this practice- studies of very poor quality- only evidence exists to support use if normal urinary tract but weak- no evidence in VUR Abx prophylaxis- 2001 Cochrane review- efficacy unknown- studies poorly designed with biases known to overestimate tx effect, large well done studies needed to determine efficacy
Routine imaging has not been shown to decrease # of recurrent utis or renal damage. However, routine use of prophylactic abx is increased 6 fold with use.
2004 prospective study renal us did not change management of uti in any of 255 kids < 5yo admitted with first uncomplicated febrile UTI DMSA not mentioned in AAP guidelines. Cincinnati Children’s Hospital recs only if identification of acute pyelo or renal scarring will change management (better at identifying scarring than us).
RNC does not recognize anatomy of urethra and bladder well so cannot identify posterior urethral valves in boys
The film was taken during voiding. The bladder is full and contrast is seen to travel in retrograde fashion up both ureters (reflux). Notice that there is no nephrogram (no contrast in the renal parenchyma). This tells us that this image was obtained by putting contrast into the bladder, not by injecting contrast intravenously
Grade I- into distal ureter Grade II- up ureter into pelvis and calyces. No dilatation, normal calyceal fornicies Grade III- same as II but mild dilatation of pelvis and calyces Grade IV- same as III but ureter and pelvis are moderately dilated, and the calyces are moderately blunted Grade V- gross dilatation and tortuosity of ureter, pelvis, and calyces with significant blunting of the majority of the calyces Less common in African Americans
Wheeler DM, et al. Interventions for primary VUR. Cochrane Database Syst Rev. 2004(3):CD001532.
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