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Daniel M, Szymanik-Grzelak H, Sierdziński J, Pańczyk-Tomaszewska M. Lactobacillus rhamnosus PL1 and Lactobacillus plantarum PM1 versus Placebo as Prophylaxis for Recurrence of Urinary Tract Infections in Children. Microorganisms 2024; 12:1037. [PMID: 38930419 PMCID: PMC11205481 DOI: 10.3390/microorganisms12061037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/03/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024] Open
Abstract
Urinary tract infections (UTIs) rank among the most prevalent bacterial infections in children. Probiotics appear to reduce the risk of recurrence of UTIs. This study aimed to evaluate whether probiotics containing Lactobacillus rhamnosus PL1 and Lactobacillus plantarum PM1 therapy prevent UTIs in the pediatric population compared to a placebo. A superiority, double-blind, randomized, controlled trial was conducted. In total, 54 children aged 3-18 years with recurrent UTIs or ≥one acute pyelonephritis and ≥one risk factor of recurrence of UTIs were randomly assigned (27 patients in each arm) to a 90-day probiotic or placebo arm. The age, sex, diagnosis, renal function, risk factors, and etiology of UTIs did not vary between the groups. During the intervention, 26% of children taking the probiotic had episodes of UTI, and it was not significantly less than in the placebo group. The number of UTI episodes during the intervention and the follow-up period decreased significantly in both groups, but the difference between them was insignificant. We observed a decrease in UTIs during the study of almost 50% in the probiotic group compared to the placebo group. Probiotics can be used as natural, safe prophylaxis for children with risk factors for UTIs in whom antibiotic prevention is not indicated.
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Affiliation(s)
- Maria Daniel
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.D.); (M.P.-T.)
| | - Hanna Szymanik-Grzelak
- Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.D.); (M.P.-T.)
| | - Janusz Sierdziński
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 02-091 Warsaw, Poland;
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Marsh MC, Junquera GY, Stonebrook E, Spencer JD, Watson JR. Urinary Tract Infections in Children. Pediatr Rev 2024; 45:260-270. [PMID: 38689106 DOI: 10.1542/pir.2023-006017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Despite the American Academy of Pediatrics guidelines for the evaluation, treatment, and management of urinary tract infections (UTIs), UTI diagnosis and management remains challenging for clinicians. Challenges with acute UTI management stem from vague presenting signs and symptoms, diagnostic uncertainty, limitations in laboratory testing, and selecting appropriate antibiotic therapy in an era with increasing rates of antibiotic-resistant uropathogens. Recurrent UTI management remains difficult due to an incomplete understanding of the factors contributing to UTI, when to assess a child with repeated infections for kidney and urinary tract anomalies, and limited prevention strategies. To help reduce these uncertainties, this review provides a comprehensive overview of UTI epidemiology, risk factors, diagnosis, treatment, and prevention strategies that may help pediatricians overcome the challenges associated with acute and recurrent UTI management.
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Affiliation(s)
- Melanie C Marsh
- Division of Hospital Medicine, Department of Pediatrics, Advocate Aurora Atrium Health Systems, Chicago, IL
| | - Guillermo Yepes Junquera
- Kidney and Urinary Tract Center, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Division of Infectious Diseases
| | - Emily Stonebrook
- Kidney and Urinary Tract Center, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Division of Nephrology and Hypertension, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - John David Spencer
- Kidney and Urinary Tract Center, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
- Division of Nephrology and Hypertension, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Joshua R Watson
- Center for Clinical Excellence, Nationwide Children's Hospital, Columbus, OH
- Division of Infectious Diseases
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Emami E, Mt Sherwin C, Heidari-Soureshjani S. Effect of probiotics on urinary tract infections in children: A systematic review and meta-analysis. Curr Rev Clin Exp Pharmacol 2022; 19:CRCEP-EPUB-123117. [PMID: 35507743 DOI: 10.2174/2772432817666220501114505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/11/2022] [Accepted: 03/14/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) are the most prevalent bacterial infections that occur in children worldwide. OBJECTIVE This meta-analysis aims to investigate the utility of probiotics as preventive therapy in children with a UTI. METHODS The Web of Science, PubMed, and Scopus were searched for articles that investigated the relationship between probiotic consumption and the risk of UTIs. The quality of the articles was evaluated using the Jadad scale. The pooled odds ratio (OR) and 95% confidence interval (CI) were calculated using a random-effects model. Subgroup analyses and sensitivity analyses were also conducted. The Cochran Q test and the statistic I2 were used to evaluate heterogeneity. To determine any potential publication bias, the Egger's and Begg's tests were used. RESULTS In total, eleven studies were selected for systematic review and meta-analysis. Compared to children who did not receive probiotics, the OR of developing or having a recurring urinary tract infection in those who received probiotics was 0.94 (95% CI; 0.88-0.999; p-value=0.046). The Begg's and Egger's tests showed no evidence of publication bias between probiotics and the risk of developing new or recurring urinary tract infections. CONCLUSION Based on this systematic review and meta-analysis, probiotics could be an alternative therapy for children who are at risk of developing a UTI. They are non-pharmaceutical options and could be used as natural prophylaxis for UTIs. However, the currently published evidence does not irrefutably confirm that probiotics provide a protective effect against urinary bacterial infections. Therefore, there need to be large-scale randomized clinical trials undertaken to investigate the possible prophylaxis of probiotics.
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Affiliation(s)
- Elham Emami
- Emam Hossein Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Catherine Mt Sherwin
- Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton Children\'s Hospital, One Children\'s Plaza, Dayton, Ohio, USA
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Hudson RE, Job KM, Sayre CL, Krepkova LV, Sherwin CM, Enioutina EY. Examination of Complementary Medicine for Treating Urinary Tract Infections Among Pregnant Women and Children. Front Pharmacol 2022; 13:883216. [PMID: 35571128 PMCID: PMC9094615 DOI: 10.3389/fphar.2022.883216] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 04/12/2022] [Indexed: 01/27/2023] Open
Abstract
Urinary tract infections (UTIs) are a significant clinical problem that pregnant women and children commonly experience. Escherichia coli is the primary causative organism, along with several other gram-negative and gram-positive bacteria. Antimicrobial drugs are commonly prescribed to treat UTIs in these patients. Conventional treatment can range from using broad-spectrum antimicrobial drugs for empirical or prophylactic therapy or patient-tailored therapy based on urinary cultures and sensitivity to prospective antibiotics. The ongoing emergence of multi-drug resistant pathogens has raised concerns related to commonly prescribed antimicrobial drugs such as those used routinely to treat UTIs. Consequently, several natural medicines have been explored as potential complementary therapies to improve health outcomes in patients with UTIs. This review discusses the effectiveness of commonly used natural products such as cranberry juice/extracts, ascorbic acid, hyaluronic acid, probiotics, and multi-component formulations intended to treat and prevent UTIs. The combination of natural products with prescribed antimicrobial treatments and use of formulations that contained high amounts of cranberry extracts appear to be most effective in preventing recurrent UTIs (RUTIs). The incorporation of natural products like cranberry, hyaluronic acid, ascorbic acid, probiotics, Canephron® N, and Cystenium II to conventional treatments of acute UTIs or as a prophylactic regimen for treatment RUTIs can benefit both pregnant women and children. Limited information is available on the safety of natural products in these patients' populations. However, based on limited historical information, these remedies appear to be safe and well-tolerated by patients.
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Affiliation(s)
- Rachel E. Hudson
- Department of Pediatrics, Post-Doctoral Fellow, Division of Clinical Pharmacology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Kathleen M. Job
- Department of Pediatrics, Research Assistant Professor, Division of Clinical Pharmacology, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Casey L. Sayre
- Department of Pediatrics, Research Assistant Professor, Division of Clinical Pharmacology, University of Utah School of Medicine, Salt Lake City, UT, United States
- College of Pharmacy, Roseman University of Health Sciences, South Jordan, UT, United States
| | - Lubov V. Krepkova
- Head of Toxicology Department, Center of Medicine, All-Russian Research Institute of Medicinal and Aromatic Plants (VILAR), Moscow, Russia
| | - Catherine M. Sherwin
- Department of Pediatrics, Vice-Chair for Research, Professor, Wright State University Boonshoft School of Medicine/Dayton Children’s Hospital, Dayton, OH, United States
| | - Elena Y. Enioutina
- Department of Pediatrics, Research Assistant Professor, Division of Clinical Pharmacology, University of Utah School of Medicine, Salt Lake City, UT, United States
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Non-antibiotic Approaches to Preventing Pediatric UTIs: a Role for D-Mannose, Cranberry, and Probiotics? Curr Urol Rep 2022; 23:113-127. [PMID: 35441976 DOI: 10.1007/s11934-022-01094-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW While antibiotics have been a staple in the management and even prevention of urinary tract infections (UTIs), it is not without significant consequences due to intolerance and development of antibiotic resistant bacteria. These concerns necessitate alternatives to antibiotic use in the management of pediatric UTIs. This review seeks to evaluate non-antibiotic means of preventing UTI in the pediatric population. RECENT FINDINGS The search for preventative alternatives to antibiotics has included D-mannose, cranberry, and probiotics. These products similarly work through competitive inhibition of uropathogens in the urinary tract. Pediatric studies exist highlighting the use of cranberry extract/juice and probiotics in UTI prevention, although significant heterogeneity amongst studies have limited overarching recommendations for their use. Data of D-mannose use is extrapolated from adult literature. More studies are required in the utility of each treatment, with some emphasis on larger sample sizes and clarifications regarding dosing and formulation.
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Daniel M, Szymanik-Grzelak H, Turczyn A, Pańczyk-Tomaszewska M. Lactobacillus rhamnosus PL1 and Lactobacillus plantarum PM1 versus placebo as a prophylaxis for recurrence urinary tract infections in children: a study protocol for a randomised controlled trial. BMC Urol 2020; 20:168. [PMID: 33097017 PMCID: PMC7583233 DOI: 10.1186/s12894-020-00723-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 09/17/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are one of the most common bacterial infections in children. In children < 7 years of age, the prevalence of one episode of symptomatic UTI has been estimated at 3-7% in girls and 1-2% in boys, whereas 8-30% of them will have one or more episodes of UTI. The use of some probiotics appears to reduce the risk of recurrence of UTIs. Since the effects of probiotics are strain-specific, the efficacy and safety of each strain has to be assessed. The main aim of this study is to determine whether probiotics (containing Lactobacillus rhamnosus PL1 and Lactobacillus plantarum PM1) therapy are effective in preventing UTI in children compared to placebo. METHOD A superiority, double-blind, randomised, controlled trial is being conducted. One hundred and six patients aged 3 to 18 years with recurrent UTIs in last year (defined as: ≥ 2 episodes of UTI with acute pyelonephritis/upper UTI; or 1 episode of UTI with acute pyelonephritis and ≥ 1 episodes of UTI with cystitis/lower UTI; or ≥ 3 episodes of UTI with cystitis/lower UTI) or children with ≥ 1 infection in the upper urinary tract and ≥ 1 of recurrent UTIs risk factors (congenital anomalies of the kidney and urinary tract, constipation, bladder dysfunction, myelomeningocele, sexual activity in girls) will be randomly assigned to receive a 90-day prophylaxis arm (probiotic containing L. rhamnosus PL1 and L. plantarum PM1) or a 90-day placebo arm. The primary outcome measure will be the frequency of recurrence of UTI during the intervention and in the period 9 months after the intervention. DISCUSSION The findings of this randomised controlled trial (RCT), whether positive or negative, will contribute to the formulation of further recommendations on prevention of recurrent UTIs in children. TRIAL REGISTRATION NUMBER NCT03462160, date of trial registration 12th March 2018.
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Affiliation(s)
- Maria Daniel
- Department of Paediatric Nephrology, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland
| | - Hanna Szymanik-Grzelak
- Department of Paediatric Nephrology, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland.
| | - Agnieszka Turczyn
- Department of Paediatric Nephrology, Medical University of Warsaw, Żwirki i Wigury 63A, 02-091, Warsaw, Poland
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Sadeghi-Bojd S, Naghshizadian R, Mazaheri M, Ghane Sharbaf F, Assadi F. Efficacy of Probiotic Prophylaxis After The First Febrile Urinary Tract Infection in Children With Normal Urinary Tracts. J Pediatric Infect Dis Soc 2020; 9:305-310. [PMID: 31100124 DOI: 10.1093/jpids/piz025] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 04/29/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Growing antibiotic resistance and debates over their efficacy for urinary tract infection (UTI) recurrence warrants studying nonantibiotic prophylaxis for preventing UTI recurrences. METHODS We randomly assigned 181 children, aged 4 months to 5 years, with a normal urinary tract after recovery from their first febrile UTI in a 1:1 ratio to receive a probiotic mixture of Lactobacillus acidophilus, Lactobacillus rhamnosus, Bifidobacterium bifidum, and Bifidobacterium lactis (n = 91) or placebo (n = 90) for a total of 18 months of therapy. The primary objective was to show the superiority of probiotic prophylaxis to placebo. The primary end point was composite cure (UTI-free survival) at 18 months, and the secondary end point was the median time to first UTI recurrence. RESULTS The probiotics were superior to placebo with respect to the primary efficacy end point. At 18 months, composite cure was observed in 96.7% (3 of 91) of the patients in the probiotic group and 83.3% (15 of 90) of those in the placebo group (P = .02). The median time to the first incidence of UTI recurrence was 3.5 months (range, 1-4 months) and 6.5 months (range, 2-14 months) in the probiotic and placebo groups, respectively (P = .04). The main microorganism that caused recurrent UTI was Escherichia coli, followed by Klebsiella pneumoniae, and these results were not significantly different between the 2 groups. We found no specific adverse events among the participants who received the probiotic mixture during the course of therapy. CONCLUSIONS The probiotics were more effective than placebo at reducing the risk of recurrent UTI in children with a normal urinary tract after their first episode of febrile UTI.
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Affiliation(s)
- S Sadeghi-Bojd
- Department of Pediatrics, Division of Nephrology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - R Naghshizadian
- Department of Pediatrics, Section of Nephrology, Kurdistan University of Medical Science, Sanandaj, Iran
| | - M Mazaheri
- Department of Pediatrics, Section of Nephrology, Semnan University of Medical Science1 Semnan, Iran
| | - F Ghane Sharbaf
- Department of Pediatrics, Division of Nephrology, Dr Sheikh Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - F Assadi
- Department of Pediatrics, Division of Nephrology, Rush University Medical Center, Chicago, Illinois
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8
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Beetz R. Ist die antibakterielle Langzeitprophylaxe immer noch alternativlos? Urologe A 2020; 59:255-260. [DOI: 10.1007/s00120-020-01139-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Wang J, Zhu H, Huang L, Zhu X, Dong J, Sha J, Gu N, Ge Z, Deng Y, Ma G, Guo Y. Risk factors affecting the prognosis of urinary tract infection in Chinese pediatric patients: Single-center experience. Pediatr Int 2020; 62:189-192. [PMID: 31520502 DOI: 10.1111/ped.14007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/12/2019] [Accepted: 08/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Urinary tract infection (UTI) is common in children. The purpose of this retrospective study was to determine the various risk factors that usually affect the prognosis of UTI in children diagnosed with the disease. METHODS In the present retrospective study, we enrolled all pediatric patients diagnosed with UTI and hospitalized between 1 January 2013 and 31 July 2016 at Nanjing Children's Hospital. We then collected all the relevant patient clinical demographics and characteristics. RESULTS The study involved 2,092 pediatric patients diagnosed with UTI. On logistic regression analysis, factors that could affect the prognosis of pediatric UTI were complications, hospitalization, intensive care unit (ICU) admission, type of UTI, urine culture results, blood lymphocytes, urine nitrites (NIT) and antibiotics (unstandardized coefficients, 0.06, <0.001, -0.28, 0.32, <0.001, 0.01, -0.11, 0.01, respectively, all P < 0.001). CONCLUSION Complications, hospitalization, type of UTI, urine culture results, blood lymphocytes, and antibiotics had a significant, positive association with UTI prognosis. Meanwhile, ICU admission and urine NIT had a negative association with prognosis.
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Affiliation(s)
- Jun Wang
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Haobo Zhu
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Liqu Huang
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaojiang Zhu
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jun Dong
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jintong Sha
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Nannan Gu
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zheng Ge
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yongji Deng
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Geng Ma
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yunfei Guo
- Department of Urology, Children's Hospital of Nanjing Medical University, Nanjing, China
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Khan A, Jhaveri R, Seed PC, Arshad M. Update on Associated Risk Factors, Diagnosis, and Management of Recurrent Urinary Tract Infections in Children. J Pediatric Infect Dis Soc 2019; 8:152-159. [PMID: 30053044 PMCID: PMC6510945 DOI: 10.1093/jpids/piy065] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 07/19/2018] [Indexed: 01/16/2023]
Abstract
Recurrent urinary tract infection (rUTI) continues to challenge pediatric care providers. The diagnosis of an rUTI can be difficult, especially in young febrile children. Antibiotic resistance rates continue to rise, which limits oral treatment options. Prophylactic antibiotics are used commonly to manage rUTI, but their use increases the risk of rUTI with antibiotic-resistant strains without significantly reducing renal scarring. Alternative therapies for rUTI include probiotics and anthocyanidins (eg, cranberry extract) to reduce gut colonization by uropathogens and prevent bacterial adhesion to uroepithelia, but efficacy data for these treatments are sparse. The future of rUTI care rests in addressing the following contemporary issues: best diagnostic practices, risk factors associated with rUTI, and the prevention of recurrent infection. In this review, we summarize the state of the art for each of these issues and highlight future studies that will aim to take an alternative approach to managing rUTI.
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Affiliation(s)
- Anum Khan
- School of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Ravi Jhaveri
- Division of Infectious Diseases, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine
| | - Patrick C Seed
- Ann and Robert H. Lurie Children’s Hospital and Stanley Manne Children’s Research Institute, Chicago, Illinois
| | - Mehreen Arshad
- Division of Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
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Leung AK, Wong AH, Leung AA, Hon KL. Urinary Tract Infection in Children. RECENT PATENTS ON INFLAMMATION & ALLERGY DRUG DISCOVERY 2019; 13:2-18. [PMID: 30592257 PMCID: PMC6751349 DOI: 10.2174/1872213x13666181228154940] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/26/2018] [Accepted: 12/26/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Urinary Tract Infection (UTI) is a common infection in children. Prompt diagnosis and appropriate treatment are very important to reduce the morbidity associated with this condition. OBJECTIVE To provide an update on the evaluation, diagnosis, and treatment of urinary tract infection in children. METHODS A PubMed search was completed in clinical queries using the key terms "urinary tract infection", "pyelonephritis" OR "cystitis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature and the pediatric age group. Patents were searched using the key terms "urinary tract infection" "pyelonephritis" OR "cystitis" from www.google.com/patents, http://espacenet.com, and www.freepatentsonline.com. RESULTS Escherichia coli accounts for 80 to 90% of UTI in children. The symptoms and signs are nonspecific throughout infancy. Unexplained fever is the most common symptom of UTI during the first two years of life. After the second year of life, symptoms and signs of pyelonephritis include fever, chills, rigor, flank pain, and costovertebral angle tenderness. Lower tract symptoms and signs include suprapubic pain, dysuria, urinary frequency, urgency, cloudy urine, malodorous urine, and suprapubic tenderness. A urinalysis and urine culture should be performed when UTI is suspected. In the work-up of children with UTI, physicians must judiciously utilize imaging studies to minimize exposure of children to radiation. While waiting for the culture results, prompt antibiotic therapy is indicated for symptomatic UTI based on clinical findings and positive urinalysis to eradicate the infection and improve clinical outcome. The choice of antibiotics should take into consideration local data on antibiotic resistance patterns. Recent patents related to the management of UTI are discussed. CONCLUSION Currently, a second or third generation cephalosporin and amoxicillin-clavulanate are drugs of choice in the treatment of acute uncomplicated UTI. Parenteral antibiotic therapy is recommended for infants ≤ 2 months and any child who is toxic-looking, hemodynamically unstable, immunocompromised, unable to tolerate oral medication, or not responding to oral medication. A combination of intravenous ampicillin and intravenous/intramuscular gentamycin or a third-generation cephalosporin can be used in those situations. Routine antimicrobial prophylaxis is rarely justified, but continuous antimicrobial prophylaxis should be considered for children with frequent febrile UTI.
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Affiliation(s)
- Alexander K.C. Leung
- Address correspondence to this author at the Department of Pediatrics, the University of Calgary, Alberta Children’s Hospital, #200, 233 – 16th Avenue NW, Calgary, Alberta, Canada; Tel: (403) 230 3300; Fax: (403) 230 3322; E-mail:
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Hosseini M, Yousefifard M, Ataei N, Oraii A, Mirzay Razaz J, Izadi A. The efficacy of probiotics in prevention of urinary tract infection in children: A systematic review and meta-analysis. J Pediatr Urol 2017; 13:581-591. [PMID: 29102297 DOI: 10.1016/j.jpurol.2017.08.018] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 08/11/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND A consensus has not been reached yet about the efficacy of probiotics in reducing the incidence of urinary tract infections (UTIs) in children. This systematic review and meta-analysis was designed to assess the efficacy of probiotics in prevention UTI in children. METHODS The present study was designed based on guidelines for systematic reviews of clinical trials. Two independent reviewers performed an extensive search in the Medline, Embase, Web of Science and Scopus electronic databases up to the end of 2016. The summery of eligible studies was assessed independently by two reviewers and recorded in the data extraction form. Finally, a pooled relative risk (RR) was reported with a 95% confidence interval (95% CI). RESULTS Data from 10 studies were entered in the present meta-analysis. Probiotic therapy did not have any beneficial effect on the incidence of UTI (RR = 0.94; 95% CI 0.85-1.03; p = 0.19) and its recurrence (RR = 0.93; 95% CI 0.85-1.02; p = 0.14). Subgroup analyses showed that probiotics as monotherapy do not have any beneficial effects on prevention of UTI (RR = 0.96; 95% CI 0.89-1.04; p = 0.31). However, the incidence of UTI is reduced if probiotics are used as adjuvant therapy to antibiotics (RR = 0.92; 95% CI 0.85-0.99; p = 0.02). CONCLUSION The present meta-analysis showed that probiotics did not have a beneficial effect in reducing the incidence or recurrence of UTI. Only a moderate efficacy was seen when a probiotic was used as adjuvant therapy to antibiotics.
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Affiliation(s)
- Mostafa Hosseini
- Pediatric Chronic Kidney Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Yousefifard
- Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Neamatollah Ataei
- Pediatric Chronic Kidney Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Pediatric Nephrology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Oraii
- Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Jalaledin Mirzay Razaz
- Department of Community Nutrition, Faculty of Nutrition and Food Technology, Sahib Behest University of Medical Sciences, Tehran, Iran
| | - Anahita Izadi
- Departments of Pediatric Infectious Diseases, Tehran University of Medical Sciences Tehran, Iran.
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Probiotics for Prophylaxis and Treatment of Urinary Tract Infections in Children. IRANIAN JOURNAL OF PEDIATRICS 2016. [DOI: 10.5812/ijp.7695] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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