WHAT IS THE FIRST CHOICE IN THE TREATMENT OF URINARY TRACT INFECTION IN CHILDHOOD?

The treatment of the urinary tract infections (UTI) in childhood is necessary, before the culture and sensitivity results. Physicians are searching for new therapy models in recent years, because of resistance developing to co-trimoxasol (SMX-TM).

In this study, we want to determine the efficacy of and resistance to SMX-TM and efficacy of cefuroksim akcethyl and sulbactam-ampicilline in UTI in this region of Turkey. Study group consisted of sixty children with the first UTI and without medication. UTI was diagnosed by urinary cultures and significant bacteriuria in Fuchs-Rosenthal camera. Children were selected randomly in three groups after the blood biochemistry, urine analysis, culture and sensitivities were checked, and treated with SMX-TM, cefuroksim akcethyl or sulbactam-ampicilline for ten days. Ten children we missed to follow and six with no growth in urinary culture were excluded from the study. The age range of 44 children included in this study was 6 months to 11 years and the mean age was 4.9±3.2 years; and the ratio of girls to boys was 1.2.

Out of 44, E. Coli growth in 29, Klebsiella pneumonia in 6, Proteus mirabilis in 5, Staphylococcus aureus in 2 and Pseudumonas in 1 children were detected in urinary cultures. 44.8 % of E. Coli was found resistant to SMX-TM, and lower UTI were successfully treated with SMX-TM in 62.5%, with cefuroksim akcethyl in 66.7% and with sulbactamampicilline in 75%. The treatment of upper UTI with cefuroksim akcethyl (100%) was significantly successful (p < 0.005) versus SMX-TM (40%) and sulbactam-ampicilline (85.7%).

In conclusion, sulbactam-ampicilline may be used and SMX-TM may be the first choice drug in the treatment of the first UTI episodes, and upper UTI may be treated with cefuroksim akcethyl.