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June 11, 2011

Health column: Take step to prevent and treat urinary tract infections in girls

How common are urinary tract infections in girls?

According to an article in Urologic Clinics of North America, 7 percent of girls and 2 percent of boys have had a UTI before age 6.

Studies show that girls are slightly more prone to get UTIs than boys of the same age. UTIs are most common in girls 3 to 6 years old, though children of any age who have anatomic anomalies, children who are toilet training who do not wipe properly after using the toilet and those who have diabetes are more likely to get UTIs. Older girls who are sexually active are also predisposed to get UTIs.

What are the symptoms of UTI?

Fever is common and temperatures greater than 102.2 degrees are more likely with UTIs. Irritability, tiredness, vomiting, pain on urination, or abdominal pain can occur. Infants may not want to take the normal amount of formula or fluids. In very young infants, some may have poor weight gain as the only sign. Sometimes bedwetting or daytime accidents may occur in children who were previously toilet trained.

In general, what causes UTIs?

Bacteria can cause urinary tract infections. In 40 percent of patients with urinary tract infections and fever, who had a special study of the kidney called VCUG, findings have shown that there was evidence of vesicoureteral reflux, which means urine is not passing through the urinary tract to the bladder normally. So, urine may "reflux" back up instead of being excreted out of the body.

Why are UTIs sometimes a recurring problem?

In 20 percent of patients, UTI can recur, regardless of an abnormal anatomy of the urinary tract. When reflux is present, the patient is more likely to have a recurrent urinary tract infection since bacteria are able to enter parts of the ureters and kidney that should remain sterile. Occasionally, abnormalities of the bladder can cause it to not empty properly and cause bacterial growth. Children who are constipated may have improper bladder emptying, which can predispose them to infections.

What is the treatment?

Oral antibiotics are used, and physicians will choose medications based on the bacteria. Doctors use urine cultures to help them ensure that the particular bacteria is susceptible to the chosen antibiotic.

Children who are not able to take oral antibiotics or those with lethargy, difficulty breathing, decreased appetite or vomiting and who appear ill or very young infants may need intravenous (IV) antibiotics. Some children who have resistant organisms in their urine may need IV antibiotics to treat resistant bacteria.

Some children who have an anatomic reason for the UTI may need to take a low dose antibiotic to prevent recurrent infection and scarring of the kidney. Studies are being done to evaluate the use of antibiotics to prevent UTIs in children and in some cases prophylactic antibiotics may not be necessary.

What behavioral or lifestyle changes can help prevent UTIs?

Various recent studies on use of concentrated cranberry juice have demonstrated some preventive benefits, but cannot be used to replace antibiotic treatment when needed. Good hygiene helps in girls. Also avoidance of constipation can help promote normal bladder emptying to prevent infections.

Dr. Linda M. Lukose is a pediatrician at Bassett Healthcare Network.

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