PERINATOLOGIYA I PEDIATRIYA. 2014. 3(59):91-94; doi 10.15574/PP.2014.59.91

The treatment and prophylaxis of pyelonephritis recurrences in children

Martalog P. N., Cerempei L. G., Balanuta M. P., Ciuntu A. O.,  Cenusha  F. V.

State University of Medicine and Pharmacy «Nicolae Testemitanu» Kishinau, Moldova

Purpose: to identify the risk factors, clinic features, microbiological status, the effectiveness of antibiotic therapy in the treatment and prevention of recurrent pyelonephritis among children.

Patients and methods: there were observed 75 children from 6 months to 12 years with the pyelonephritis. There were collected family history, clarified the nature of the pregnancy course, assessed the condition of children at birth and features of their development on the 1st year of life, defined the group of children with frequent episodes of acute respiratory infections, the presence of the dizembriogeneza stigmas, refined the character pathology of the urinary system. It was analyzed the clinical history and clinical course of pyelonephritis. To study the spectrum of pathogens pyelonephritis children were conducted an urine culture to determine the degree of bacteriuria, species of microorganisms, antibiotic susceptibility (in active stage of the disease, after the treatment completion). It was evaluated the nature of crystalluria in the single urine samples. To determine the possible causes of urine stasis it was carried an ultrasound and X-ray studies. It was studied the peculiarities of antibiotic therapy aimed on eliminating microbial-inflammation in the kidney and urinary tract. The diagnosis verification was carried out in accordance with the Protocol diagnosis and the pyelonephritis treatment: clinical, laboratory and instrumental.

Results: It was confirmed the high clinical efficacy of an antibiotic therapy scheme with medium-heavy pyelonephritis, with the milder forms of pyelonephritis it was used an oral antibiotics, there were the cephalosporins of II–III generation, rarely — «the protected aminopenicillins». The phytodrug Canefron-N was applied in an integrated preventive treatment of pyelonephritis, as it increases the duration of remission and reduces the number of relapses.

Conclusion: thus, at each stage of the treatment of pyelonephritis it is necessary to apply a differentiated approach to the choice of antibiotics based on the of studying the pathogens pyelonephritis structure and its resistance, taking into account the localization and severity of the process, the age of children. An antibiotic therapy algorithm should include initiation of treatment with the leading position of the Enterobacteriaceae family in the etiology of the genitourinary system infections.

Key words: children, pyelonephritis, treatment, antibacterial therapy.

REFERENCES

1. Детская нефрология. Под ред МС Игнатовой. М, Мед информ агентство, 2011: 696.

2. American Academy of Pediatrics: Section on Urology Response to New Guidelines for the Diagnosis and Management of UTI. Pediatrics. March, 2012. http://pediatrics.aap-publications.org/site/misc/reprints.xhtml

3. Craig CJ, Simpson MJ, Willians GJ et al. 2009. Antibiotic Prophylaxis and recurrent urinary tract infection in children. N Engl J Med 361: 1748—1759. http://dx.doi.org/10.1056/NEJMoa0902295 ; PMid:19864673

4. Beetz R, Westenfelder M. 2011. Antimicrobial therapy of urinary tract infections in children. Int J Antimicrob Agents 38: 42—50. http://dx.doi.org/10.1016/j.ijantimicag.2011.09.006 
PMid:22036250

5. Foxman B. 2002. Epidemiology of urinary tract infection: incidence, morbidity and economical. Am J Med 113(Suppl1A): 5—13.

6. Bing Dai, Yawei Liu, Jieshuang Jia and Changlin Mei. Long-term antibiotics for the prevention of recurrent urinary tract infection in children: a systematic review and meta!analysis. ADC Online First, publishied on May 10. 2010 as 10.1136/adc. 2009.173112.

7. Urinary Tract Infection in Children: Diagnosis, Treatment and Long-term Management: NICE Clinical Guideline. London (UK): National Institute for Health and Clinical Excellence; 2007, Аug: 148.

8. Wagenlehner F, Naber KG. 2004. Antibiotics and resistance of uropathogens. EAU Update Series 2: 125—135.

9. Williams G, Craig CJ. 2008. Diagnosis and management of urinary tract infection. Comprehensive Pediatric Nephrology. Ed. Mosby: 539—548.

10. Williams G, Craig JC. 2011. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database of Systematic Reviews 3.