Infant and child bacterial Urinary Tract Infections: advice

March 2017

In February 2007, the French Agency of sanitary security and health products (Afssaps) published recommendations to help doctors diagnose and treat with antibiotics urinary infections of bacterial origin in infant and children.

Being frequent, these infections create renal scabs which can, in the long run, cause an arterial hypertension and a nephronic reduction. Moreover, resistance to antibiotics is increasing, making the choice of antibiotics complicated and limited.


Diagnosis


For the infant, diagnosis is particularly difficult. Afssaps notes two consequences:
  • Diagnosis by excess involving the prescription of antibiotics or unnecessary imagery examinations,
  • Late or absent diagnosis exposing to complications which can be serious:
    • Septicaemia,
    • Abscess,
    • Appearance of renal cicatrices, later on.

Acute cystitis


Acute cystitis is a benign disorder, without severity. Afssaps notes that "recurrent cystitis in little girls are defined by at least 3 episodes per annum".
  • In girls over the age of 3, the signs which establish a clinical diagnosis are specifically:
    • Dysuria,
    • Burns during urination,
    • Crying while urinating,
    • Pressing urges,
    • Hypogastric pains,
    • Urinary losses,
    • Mild fever (sometimes absent).

Acute Pyelonephritis


Bacterial urinary infection, it can be the cause of renal lesions.
  • In the young child and the infant
    • The signs to establish clinical diagnosis are:
      • Unexplained fever ,
      • Digestive disorders,
      • Deterioration of the general state.
    • In older children
      • The signs to establish clinical diagnosis are:
        • Urinary signs of cystitis,
        • High fever (> 39°C),
        • Lumbar pains,
        • Stomach pains.

Complementary examinations

  • To establish diagnosis, the recommendations of Afssaps are set in the following table:




For the ECBU, to avoid the contamination, the sampling of urines in the middle of the jet (per-urination) is to be recommended.

Treatment


For treatment, we notice:
  • A great resistance (50%) to penicillins A,
  • A resistance of 20% to co-trimoxazole.

Acute cystitis

  • From age 3, with the choice of:
    • Co-trimoxazole (sulfamethoxazole and trimethoprime) in two daily intakes,
    • Or cefixime 8 mg/kg/d in 2 daily dosing (if resistance, intolerance or contraindication to co-trimoxazole".


Afssaps precises: " The duration of treatment from 3 to 5 days is recommended for the enfant. The cytobacteriologic examination of control of urines (ECBU) is useless".

Acute Pyelonephritis


The treatment advised by Afssaps lasts between 10 and 14 days and includes attack treatment via injectable routes, then a relay of oral treatment.

For children less than 3 months or "presenting clinical signs of severe infection", hospitalisation is recommended.
  • Attack treatment for 2 to 4 days:
    • Ceftriaxone 50 mg/kg/d in single daily injection,
    • Or cefotaxime (hospitalization) 100 mg/kg/d, in 3 or 4 injections,
    • Aminosides (gentamicin at the dose of 3 mg/kg/d in single daily injection,
      • In association with cephalosporines (severe pyelonephritides in the child of less than 3 months, known malformative uropathy, septicemic syndrome, immunocompromised),
      • In monotherapy (if allergy to the beta-lactamase),
      • In association with amoxicilline (100 mg/kg/d in 3-4 injections) in the event of infection with Enterococcus.
    • Treatment of relay (oral):
      • Co-trimoxazole (contra-indicated before the age of 1 month),
      • Or cefixime (as from 6 months), according to the results of the ECBU,
      • Ciprofloxacin (in the pubescent pre child, if resistance to the other families of antibiotics),
      • Fluoroquinolones (for the pubescent adolescent).


It is recommended to carry out a clinical examination, 48-72 hours after the beginning of treatment.

For the repeating IU, you can consult the recommendations pp. 8-9 du document.

Sources


Diagnosis and antibiotherapy of the Community bacterial urinary infections of the infant and the child, Afssaps, February, 2007.

Photographic copyright: © Stratum | Dreamstime.com

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