Urinary Tract Infection - Medications

Treating Children with UTIs. Children with UTIs are generally treated with TMP-SMX or cephalexin (Keflex). The optimal duration is unclear. In one major 2003 analysis, a two- to four-day treatment was as effective as seven to 14 days. If initial therapy fails, then one injection of ceftriaxone or 10 days of intravenous gentamicin nearly always cure the infection.

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Children can be treated effectively for acute pyelonephritis with oral cefixime (Suprax) or a short course (two to four days) of an intravenous (IV) antibiotic (typically gentamicin given in one daily dose). The IV antibiotic is then followed by an oral antibiotic.

Either long-term antibiotics or surgery to correct vesicoureteral reflux (VUR) are options to prevent infections in children (particularly girls) with VUR. It is unclear if either approach is any more effective than the other. Studies are finding no significant difference in kidney damage between children who are treated with antibiotics or surgery. Antibiotic treatment usually continues for years with the idea that the condition will resolve when the child has grown. A 2002 study reported that continuous antibiotics prevented infection in 72% of girls and all of boys over more than two years. Antibiotics were stopped after about four years on average, and 42% experienced UTIs or kidney infections afterward. The use of long-term antibiotics in VUR is controversial, however. There have been few well-conducted studies, and in one study, there was no difference in risk for UTI or kidney damage between patients who were taking the antibiotics and those who weren't. There is also the concern of increasing the rates of bacteria that are resistant to common antibiotics.

Management of Catheter-Induced Urinary Tract Infections

Preventing Catheter-Induced Infections

Catheter-induced urinary tract infections are very common and preventive measures are extremely important. Catheters should not be used unless absolutely necessary, and they should be removed as soon as possible. Reducing the risk for infections during long-term catheter use, however, remains problematic.

Catheter Coatings. Catheter coatings, such as silver nitrate, antibiotics, and other substances, are being tested and are showing some benefits, but the problem is still not resolved. One promising catheter (LoFric) uses a so-called hydrophilic coating consisting of PVP (polyvinyl pyrrolidone) and salt. It attracts water to the catheter surface, putting up a water barrier to reduce friction. In a 2003 study, it was associated with significantly fewer UTIs.

Intermittent Use of Catheters. If a catheter is required for long periods, it is best to use it intermittently if possible (as opposed to an indwelling catheter). Some doctors recommend replacing it every two weeks to reduce the risk of infection and irrigating the bladder with antibiotics between replacements.

Daily Hygiene. A typical catheter is one that has been preconnected and sealed and uses a drainage bag system. To prevent infection, some of the following tips may be helpful:

Drink plenty of fluids, including three glasses of cranberry juice a day.
The catheter tube should be free of any knots or kinks.
Clean the catheter and the area around the urethra with soap and water daily and after each bowel movement. (Women should be sure to clean front to back.)
Wash hands before touching the catheter or surrounding area.
Never disconnect the catheter from the drainage bag without careful instructions from a health professional on strict methods for preventing infection.
Keep the drainage bag off the floor.
Stabilize the bag against the leg using tape or some other system.

Antibiotics for Catheter-Induced Infections

Patients using catheters who develop UTIs with symptoms should be treated for each episode with antibiotics and the catheter should be removed, if possible. A major problem in treating catheter-related UTIs is that the organisms involved are constantly changing. Because there are likely to be multiple species of bacteria, experts generally recommend an antibiotic that is effective against a wide variety of microorganisms. These medications include those in the fluoroquinolone group and drug combinations such as ampicillin plus gentamicin or imipenem plus cilastatin.

Although high bacteria counts in the urine (bacteriuria) occur in most catheterized patients, administering antibiotics to prevent a UTI is rarely recommended. Many catheterized patients do not develop symptomatic urinary tract infections even with high bacteria counts. If bacteriuria occurs without symptoms, antibiotic therapy has little benefit if the catheter is to remain in place for a long period.

Catheterization is accomplished by inserting a catheter (a hollow tube, often with and inflatable balloon tip) into the urinary bladder. This procedure is performed for urinary obstruction, following surgical procedures to the urethra, in unconscious patients (due to surgical anesthesia, coma, etc.), or for any other problem in which the bladder needs to be kept empty (decompressed) and urinary flow assured. Catheterization in males is slightly more difficult and uncomfortable than in females because of the longer urethra.