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Recurrent urinary tract infections in children:Preventive interventions other than prophylactic antibiotics

World Journal of Methodology 2015年第2期5卷 13-19页

作者： Kishor Tewary Hassib Narchi Department of Pediatrics University Hospitals of North Midlands Department of Pediatrics College of Medicine and Health SciencesUnited Arab Emirates University

Urinary tract infection （UTI） is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such as hypertension and chronic renal failure. To prevent such damage, several interventions to prevent UTI recurrences have been tried. The most established and accepted prevention at present is low dose long-term antibiotic prophylaxis. However it has a risk of break through in-fections, adverse drug reactions and also the risk of developing antibiotic resistance. The search is therefore on-going to fnd a safer, effective and acceptable alter-native. A recent meta-analysis did not support routine circumcision for normal boys with no risk factors. Vacci-nium Macrocarpon （cranberry）, commonly used against UTI in adult women, is also effective in reducing the number of recurrences and related antimicrobial use in children. Sodium pentosanpolysulfate, which prevents bacterial adherence to the uroepithelial cells in animal models, has shown conflicting results in human trials. When combined with antibiotic, Lactobacillus acidophilus （LA-5） and Bifidobacterium, by blocking the in vitro attachment of uropathogenic bacteria to uroepithelial cells, significantly reduce in the incidence of febrile UTIs. Deliberate colonization of the human urinary tract of patients with recurrent UTI with Escherichia-coli （E. coli ） 83972 has resulted in subjective beneft and less UTI requiring treatment. The non-pathogenic E. coli isolate NU14 DeltawaaL is a candidate to develop live-attenuated vaccine for the treatment and prevention of acute and recurrent UTI. Diagnosing and treating dysfunctional elimination syndromes decrease the incidence of recurrent UTI. A meta-analysis found the lack of robust prospective randomized controlled trials limited the strength of the established guidelines for surgical management of vesicoureteral reflux. In conclusion, several interventions,

关键词： Kidney Recurrence/prevention Urinary tracinfections vesico-ureteral refux Vaccinium macrocarponCircumcision Vaccination Constipation Lactobacillus

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