Management Urinary Tract Infection

Management: Urinary Tract Infection Diagnostic Tests Curative – Specific – Supportive Diet Physical Activity Prophylactic Preventive Health Care

Management: Diagnostic Tests Urinalysis Ultrasound – rule out hydronephrosis & renal or perirenal abscesses – may show acute pyelonephritis

Management: Diagnostic Tests Voiding Cystourethrogram (VCUG) – indications: All children younger than 5y/o Any child with a febrile UTI School aged girls who had 2 or more UTIs Any male with UTI – most common finding is vesicoureteral reflux

Management: Diagnostic Tests Dimercaptosuccinic Acid Scan (DMSA Scan) – functional & obstruction anomaly – supports the diagnosis of pyelonephritis with a finding of photopenia – most sensitive & accurate study to demonstrate renal scarring

Mangement: Curative Specific – Antibiotics – Anti-pyretic – Analgesic

Mangement : Curative Trimethoprim-sulfamethoxazole (Co-trimoxazole) – folic acid synthesis inhibitor – given if culture & sensitivities are not yet available – effective against most strains of E.coli – dosing: 40 mkd SMX & 8 mkd TMP q 12 h – preparation: 200mg SMX & 40mg TMP/ 5ml – AE: Stevens-Johnson Syndrome, hepatitis, cholestatic jaundice, megaloblastic anemia

Management : Curative Amoxicillin, Ampicillin – interferes with bacterial cell wall synthesis – also effective as TMP-SMX – dosing: 40 mkd q 8 h – preparation: 100mg/ml, 125mg/5ml, 250mg/5ml – AE: Diarrhea, indigestion, occassional rash either urticarial or erythematous

Management : Curative Cephalosporins – 2 nd or 3 rd generation – Inhibits cell wall synthesis – dosing: mkd q 6 h – preparation: 100mg/ml, 125mg/5ml, 250mg/5ml – AE: thrombophlebitis, diarrhea

Management : Curative Ciprofloxacin – inhibits DNA Gyrase and topoisomerase IV preventing replication and repair – alternative agent for resistant microorganisms like Pseudomonas – dosing: mkd q 12 h – preparation: 100 mg, 250 mg, 500 mg, 750 mg, 1000 mg – AE: arthropathy, tendon damage, torsades de pointes

Management : Curative Gentamicin – inhibits bacterial protein synthesis – combined with ampicillin – dosing: 40 mkd q 6 h – preparation: 100mg/2.5ml, 200mg/5ml, 400mg/5ml – AE: ototoxicity, nephrotoxicity

Management : Curative Paracetamol – inhibits COX – anti-pyretic and analgesic – dosing: mkd q 4 h – preparation: 125mg/5ml, 250mg/5ml – AE: ototoxicity, nephrotoxicity

Management : Curative Supportive – Diet Increased oral fluid intake – Physical Activity Frequent voiding – Prophylactic Proper genital hygiene Strict hand-washing Avoid infrequent voiding

Management: Preventive Health Care At 3 years of age: – Vaccines MMR 2 Varicela Influenza – Blood pressure monitoring – Nutrition counseling