50. Wadland wc, Planten da.
Screening for asymptomatic bacteriuria in pregnancy. A decision and cost analysis. J Fam Pract 1989; 29: 372-376.
51. Bailey RR.
Single-dose/short-term therapy in children and in pregnant women. Infection 1994; 22 (Suppl 1): S47-S48.
52. Pfau A, Sacks TG.
Effective prophylaxis for recurrent UTIs during pregnancy. Clin Infect Dis 1992; 14: 810-814.
53. Pfau A.
Recurrent UTI in pregnancy. Infection 1994; 22 (Suppl 1): S49.
54. Gilstrap LC, Cunningham FG, Whalley PJ.
Acute pyelonephritis in pregnancy: a retrospective study. Obstet Gynecol 1981; 57: 409-413.
55. Raz R, Stamm WE.
A controlled-trial of intravaginal estriol in postmenopausal women with recurrent UTIs. N Engl J Med 1993; 329: 753-756.
56. Pfau A, Sacks T.
The bacterial flora of the vaginal vestibule, urethra and vagina in the normal premenopausal woman. JUrol 1977; 118: 292-295.
57. Privette M, Cade R, Peterson J, Mars D.
Prevention of recurrent urinary tract infections in postmenopausal women with urogenital infections. Nephron 1988; 50: 24-27.
Kirkengen AL, Andersen P, Gjersoe E, Johannessen GR, Johnsen N, Bodd E. Oestriol in the prophylactic treatment of recurrent UTIs in postmenopausal women. Scand J Prim Health Care 1992; 10: 139-142.
Raz R, Rottensterich E, Leshem Y, Tabenkin H.
Double-blind study comparing 3-day regimens of cefixime and ofloxacin in treatment of uncomplicated UTIs in women. Antimicrob Agents Chemother 1994; 38: 1176.
60. Vorland lh, Carlson k, Aalen odd.
An epidemiological survey of UTIs among outpatients in Northern Norway. Scand J Infect Dis 1985; 17: 272.
61. Stamm WE.
UTIs in young men. In: UTIs: Infectiology. Bergan T (ed). Basel: Karger, 1997; 46-47.
62. Krieger JN, Ross SO, Simonson JM.
UTIs in healthy university men. J Urol 1993; 149: 1046.
3.
UTI's IN CHILDREN
3.1 SUMMARY
The
clinical presentation of a UTI in infants and young children can be
very atypical. Investigation should beundertaken
after two episodes of a UTI in girls and one in boys. The objective
is to rule out the unusual occurrence of obstruction,
vesico-ureteric reflux (VUR) and a neuropathic spinal disorder.
Phimosis, labial adhesions and constipation may also be relevant.
Ultrasonography of the renal tract is the imaging investigation of first choice, supplemented by voiding cysto-urethrography (VCU) in infants and very young children. Later on in childhood, the VCU is replaced by indirect radionuclide cystography.
Chronic pyelonephritic renal scarring develops very early in life due to the combination of a UTI, intra-renal reflux and VUR. It sometimes arises in utero due to dysplasia. New scars very rarely develop after the age of 2 years. It is unlikely that very early identification and treatment of reflux can significantly alter the incidence of reflux nephropathy and therefore screening for asymptomatic bacteriuria in infants is of little benefit.
VUR is treated with long-term prophylactic antibiotics and surgical re-implantation is reserved for the small number of children with break-through infection.
The principles for the treatment of a UTI in children are slightly different from those for adults. Short courses are not generally accepted and therefore treatment is continued for 7-10 days. If the child is severely ill with vomiting and dehydration, hospital admission will be required and parenteral antibiotics given for at least the first 2 days. Tetracyclines and fluoroquinolones should not be given because of their effects on teeth and cartilage.