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Travelling abroad with children 

Travelling abroad with children
Chapter:
Travelling abroad with children
DOI:
10.1093/med/9780198729228.003.0038
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date: 19 November 2019

Urinary tract infection (UTI) is the commonest serious bacterial infection in childhood, affecting 11.3% of girls and 3.6% of boys under 16 years. UTI is defined as significant bacteriuria in the presence of symptoms. Gut coliforms are the responsible organisms, and disease severity depends on bacterial virulence and host susceptibility factors, ranging from mild cystitis to severe pyelonephritis. Prompt diagnosis and antibiotic treatment are important for a quick and uncomplicated recovery, which is the case for the majority of affected children. Diagnosis remains challenging for young, not toilet-trained children due to non-specific clinical presentation and practical difficulties in appropriate urine sample collection. Oral antibiotics are well effective, and long intravenous regimens are only exceptionally necessary beyond the neonatal period. Local sensitivity data are important to guide antibiotic policies in the face of increasing resistance of uropathogens. Non-antibiotic adjunctive therapy, such as steroids, vitamin A, and probiotics, have been reported to be beneficial. The subsequent management of children with UTI has for long been controversial. The long-term consequences of UTI and the associated policies of extensive imaging and routine prophylactic antibiotics are currently being questioned. Although, in a significant number of children with UTI, an underlying urological abnormality is present, more commonly vesicoureteral reflux, its detection is of little importance for further management or long-term outcome. Current guidelines for UTI management emphasize a prompt diagnosis, call for significant imaging reduction, and discourage the routine use of prophylaxis, pointing to a patient-tailored policy in the near future.

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