Clinical Reference Systems: Pediatric Advisor 10.0
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Description

A urinary tract infection (UTI) is an infection of the bladder and sometimes the kidneys. If the bladder is infected, it is called cystitis. If the kidneys are infected, it is called pyelonephritis. It is important to treat UTIs so that the kidneys are not damaged.

Various symptoms are possible:

• painful urination
• an urgent need to urinate
• frequent urination
• daytime and nighttime wetting
• dribbling
• foul-smelling urine
• fever
• stomachaches (especially lower abdomen)
• vomiting.

Cause

Urinary tract infections are caused by bacteria. The bacteria enter the bladder by traveling up the urethra. In general, the urethra is protected, but if the opening of the urethra (or the vulva in girls) becomes irritated, bacteria can grow there. Common irritants are bubble bath and shampoos. Sexual intercourse or careless wiping after a bowel movement might also cause irritation. A rare cause of UTIs (1% of girls and 5% of boys) is obstruction of the urinary tract, which results in incomplete emptying of the bladder.

Expected Course

With treatment, your fever should be gone and symptoms should be better by 48 hours after starting the antibiotic. The chances of getting another UTI are about 50%. Read the advice on preventing UTIs to decrease your risk.

HOME TREATMENT

1. Antibiotics

   You need the antibiotic prescribed by your physician. This medicine will kill the bacteria that are causing the UTI.

   Try not to forget any of the doses. Take the medicine until all the pills are gone. Even though you will feel better in a few days, take the antibiotic for the full 10 days to keep the UTI from flaring up again.

2. Extra fluids

   Drink extra fluids to help clear the infection.

3. Fever and pain relief

   Take acetaminophen or ibuprofen for the painful urination or for fever over 102 degrees F (39 degrees C).

4. Medical follow-up

   Two days after you begin antibiotics, it is important to contact your physician to find out the results of the urine culture and make sure that your infection is responding to the antibiotic.

   About 2 weeks after your initial visit your physician will want to see you for another urine culture. Because the chances are high that you will develop a second infection (50% of cases), your physician will probably also want to check your urine 1, 4, and 12 months after the first infection has cleared up.

5. Instructions for collecting a midstream, clean-catch urine specimen at home

   If you are asked to bring a urine sample to your physician's office, try to collect the urine when you first urinate in the morning. Use a jar and lid that have been sterilized by boiling for 10 minutes.

   For Girls: Wash the genital area several times with a clean washcloth and warm water. Sit on the toilet seat with your legs spread widely so that the labia (skin folds of the vagina) don't touch. Start to urinate into the toilet and then place the clean container directly in line with the stream of urine. Remove it after you have collected a few ounces but before you stop urinating. (The first or last drops that come out of the bladder may be contaminated with bacteria.)

   Keep the urine in the refrigerator until you take it to your physician's office. Try to keep it chilled when you bring it to the office (that is, put the jar in a plastic bag with some ice).

Prevention of Urinary Tract Infections

• Urinate at least every 3 to 4 hours during the day and don't "hold back."
• Urinate after baths.
• Sexually active young women should urinate after intercourse.
• Wipe correctly from front to back, especially after a bowel movement.
• Don't put bubble bath, shampoo, or other soaps into the bathwater. Don't let a bar of soap float around the tub.
• Don't become constipated. Try to have a BM every day.
• Drink enough fluids each day to keep the urine light-colored.

Call Your Physician Immediately If:

• You start having back pain.
• You start feeling very sick.

Call Your Physician During Office Hours If:

• Fever or painful urination lasts more than 48 hours after you start taking an antibiotic.
• You have other concerns or questions.