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Early Antibiotic Treatment of Pediatric Urinary Tract Infections Lowers Risk for Renal Scars

Summary and Comment |
January 29, 2014

Early Antibiotic Treatment of Pediatric Urinary Tract Infections Lowers Risk for Renal Scars

  1. F. Bruder Stapleton, MD

Children given antibiotics within 3 days after symptom onset had fewer scars than those treated later.

  1. F. Bruder Stapleton, MD

Despite experimental evidence, debate continues about whether renal parenchymal scars in children with urinary tract infection (UTI) can be prevented by prompt antibiotic treatment. Researchers in the United Kingdom capitalized on changes in UTI treatment guidelines for general practitioners, which included urgent treatment with antibiotics. They compared the timing of antibiotic administration and the development of renal scars in 2262 children <8 years of age with first UTI before the change (1992–1995) and 1664 children with first UTI after the change (2004–2011).

The incidence of renal scars declined from the 1990s to the 2000s from 0.43% to 0.18% in girls and from 0.14% to 0.05% in boys. Patients during the 2000s were younger when they presented for care and were 12 times more likely to have vesicoureteral reflux without scarring. Starting antibiotic treatment within the first 3 days after symptom onset was associated with significantly fewer renal scars than starting treatment 4 or more days after symptom onset (odds ratio, 0.37; P<0.006).

Comment

Preservation of renal function is an important outcome of treating urinary tract infection, along with elimination of the infection. These data support starting antibiotics early in young children with suspected UTI while awaiting culture results. The data also confirm long-standing experimental data in animal models of UTI.

  • Disclosures for F. Bruder Stapleton, MD at time of publication Consultant / advisory board Navigant Consulting Grant / research support NIH-NICHD; NIH-NCI Editorial boards UpToDate Leadership positions in professional societies American Board of Pediatrics (Chair, Subspecialties Committee); American Pediatric Society (Past President and Council Nominating Chair)

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Reader Comments (3)

jennifer martinez Medical Student

Time of occurrence of symptoms and time lapsed before being seen by the Physician to be taken in to consideration.Hence correct correlation is necessary.

Dr M Nagaraja Setty M.B.,B.S., Physician, Family Medicine/General Practice, Bangalore INDIA

Time of occurrence of symptoms and time lapsed before being seen by the Physician to be taken in to consideration.Hence correct correlation is necessary.

Daltro Zunino Physician, Pediatric Subspecialty, Ofice and ambulatory, besides the war of a teaching hospital

Since I became pediatric specialist (1967 and in 1973 a pediatric nephrologist) I use the microscope for the diagnosis of urinary tract infection, along with other ordinary questions abou the clinical picture. And I use to do the diagnosis by phone (all my pacientes have the neumber) and in the next day they bring the first urine, collected before the treatment and in the office I do the microscopy. As easy as that!!!! Daltro

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