Keywords: urinary tract infections in children
The key to the treatment of this disease is to actively control the infection and prevent recurrence, and support in addition to incentives to correct congenital or acquired urinary tract structural abnormalities, prevent renal dysfunction.
General treatment of acute infection should rest in bed, drink more water, urinating frequently, reduce bacteria in the bladder residence time. The girls should pay attention to the genitals clean, aggressive treatment of pinworms.
Antimicrobial therapy should be early positive application of antibacterial drug treatment. Drug selection is generally based on: ① the site of infection: pyelonephritis should choose a high blood concentration of the drug, and lower urinary tract infection should be chosen high urinary concentrations of drugs such as furans or sulfonamides; ② urine culture and drug sensitivity results; ③ kidney damage less drug. Acute primary infection by the following drug treatment, the symptoms of more than 2 to 3 days improved bacteriuria disappeared. Such as the treatment of 2 to 3 days of symptoms still did not improve or bacteriuria persists more than show that the bacteria may be resistant to the drug, should try to adjust, if necessary, the two drugs in combination.
(1) sulfa drugs: because of its strong inhibitory effect, the majority of E. coli have high solubility in urine, is not easy to produce drug resistance, cheap often initial infection drug of choice. Common agents sulfamethoxazole (sme), the combination of many synergist trimethoprim-sulfamethoxazole (tmp) (cotrimoxazole smzco). Its dose of 50mg / (kg · d) 2 times service. The general course of 1 to 2 weeks. Should drink plenty of water to prevent the formation of crystals in the urine, renal insufficiency caution.
(2) Pipemidic (pipemidicacid ppa): urine sensation caused by E. coli, their urine is high, efficacy significantly. Applicable to various types of urinary sense. Dosage of 30 ~~ 50mg / (kg · d), points 3 to 4 times a day orally. Fewer side effects, the available mild stomach discomfort. Children with caution.
(3) Furadantin: antibacterial range widely significant effect on E. coli, is not easy to produce drug resistance. Dose of 8 ~ 10mg / (kg · d), 3 times a day orally. Prone to cause gastrointestinal reactions, farmers should be taken after meals. Also tie tmp use. Furadantin connection need 3 to 4 months of treatment refractory infection should be chosen.
(4) norfloxacin; quinolones fully synthetic broad-spectrum antibacterial drugs, enriched with strong antibacterial effect against gram-negative and positive bacteria. Dose of 5 to 10mg / (kg · d), points 3 to 4 times a day orally. Its strong antibacterial activity, long-term use can lead to the flora, use should pay attention. Generally not used for child care.
(5) aminobenzyl penicillin, first bee neomycin: are broad-spectrum antibiotics, better antimicrobial effect, commonly used in the treatment of urinary flu. Kanamycin, gentamicin, although better inhibition, but because of their kidney mildew resistance and also have an adverse effect on hearing, and should be used carefully.
Treatment acute infection such as antibiotics, sensitive to the bacteria, the general 10-day course of infection was the vast majority of patients can be controlled, if not accompanied by fever five days of treatment may be sufficient. After recovery should be regular follow-up years or longer. Because the majority of recurrence is due to re-infection, and therefore not in favor of long-term therapy for all patients. Specific recommendations are as follows: infrequent recurrence, the recurrence of acute treatment; ② repeated recurrence, acute symptom control to available smzco, Furadantin, a small dose (in Pipemidic or norfloxacin therapeutic dose of 1/3 to 1/4) every night at bedtime, treatment of sustainable 3 to 6 months. Repeated infections or renal parenchyma have been different injuries, treatment can be the Director of 1 to 2 years. In order to prevent drug-resistant strains, can be a combination or alternation of medication, 2 to 3 weeks after each drug rotation to use, in order to improve the efficacy.
Active treatment about half of the urinary tract structural abnormalities in children with urinary tract infection may be associated with a variety of incentives, more particularly in chronic or repeated recurrence urine sensation accompanied by urinary tract structural abnormalities, we must actively find treatment as soon as possible, to prevent renal parenchyma damage.