Children are more prone for UTI than adults, and this is mainly because of a few anatomical
factors and a few physiological factors. Anatomical factors, UTI is more common in boys less than
six months and that is with malformations of kidneys or vesicoureteral reflux which
is common in males at that age. After six months the girls take over and that is because
of the urethra which is the urinary passage is quite short and it is situated quite in
proximity with the back passage which is basically the breeding germs area and when there is
a lack of hygiene such as back to front wiping the germs can easily be brought into the front
passage and cause a UTI. That's why children are having more UTI incidences than adults.
Now treatment - when you talk of UTI treatment I make a rule of three,
so three factors to consider - firstly what is the age of the child,
whether it is zero to six months, six months to three years, or above three years
and what is the location, whether it is upper UTI, that's towards the kidneys and the urethra which is
the kidney tube or it is the lower UTI which is bladder or below
and third is what type is the UTI so whether it is a simple UTI caused by a germ called e-coli
which is the most common and probably more benign, and whether the child responds within 48 hours to the
antibiotics, that is a simple UTI - or whether it is an atypical UTI which is anything apart
from a simple UTI, anything apart from e-coli organism or if the child is not responding
to antibiotics within 48 hours or if the child is unwell.
And third is the recurrent UTI when they are having more than two to three episodes
of urinary infections, one after another.
So it very much depends on these three factors and then we decide on the treatment modality
which is mostly antibiotic, it can be given orally or intravenously and duration varies
from three days up to two weeks depending again on the above three factors, what modality
and duration we choose.
Lastly are there investigations, so there are three investigations mostly,
one is an ultrasound of the kidney, one is nuclear imaging called DMSS scan
which picks up kidney scarring, and third is MCUG which is micturating cystourethrogram
so in that one we basically put a dye through a catheter in the bladder and then we check
for if there is any urinary reflux going back towards the kidneys, so depending on these
then we decide the duration of the antibiotic and whether the child is going on long term
prophylaxis or not. If the child is having a recurrent UTI or a reflux then you can put
the child on a long term night time antibiotics.
Finally the parents and child need to be educated
how to prevent urinary tract infection, so they should make sure that there is a regular
liquid intake, there is a regular bladder habits, so they empty bladder every two to
four hourly, there is a good hygiene, so I prefer showers every day to make sure that
front part is clean and finally taking care of bowel habits such as preventing constipation
because that can cause residual urine in the bladder and that can feed the germs.