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Forum Name: Miscellaneous Nephrology Topics

Question: 14yr old recurring UTIs


 jeannie2402 - Tue Sep 30, 2003 3:42 pm

My 14yr old daughter (not sexually active, not started her period) is now on her 5th UTI within 4 months. The first couple of infections were found to be the bacteria Staph. saprophyticus ot E.Coli. She was given Trimethoprin. For this initial UTI she was hospitalised as she was suffering from severe lower back pain on one side, vomiting, headache and generally unwell - even pins and needles occurring.
Within a couple of weeks she had a recurring infection and again given antibiotics.
Each time she was given antibiotics. For the latest episode, no sooner had she finished the course of antibiotics than she complained of slight burning sensation on urination and frequency of urination. Within 2 weeks of this infection she is now suffering from severe pain in her lower left back, headache, general unwellness and minor symptoms of cystitis.
She drinks plenty, including Cranberry juice, does not use intimate sprays, only wears cotton underwear, takes care on cleaning herself after using the bathroom etc etc.

I have started to give her a herbal tincture of Uva Ursi (bearberry) to help strengthen her urinary system, but am at a loss as to what else I can do - especially as the usual reaction is to dose her with yet another course of antibiotics - which doesn't seem to solve the problem either.

Has anyone any ideas on how and why she keeps getting these recurring infections, especially as it has been the Staph. bacteria and suggestions on treatment short and long term. I do not want her to be on antibiotics continually but also do not want to risk damage to her kidneys.
 Dr. Tamer Fouad - Mon Nov 17, 2003 6:47 pm

User avatar Jeanie,
Recurrent infections of the urinary tract should be classified as same-strain or different-strain and as early (occurring within 2 weeks of the end of therapy) or late.
After therapy, early recurrences due to the same strain may result from an unresolved upper tract focus of infection but often (especially after short-course therapy for cystitis) result from persistent vaginal colonization. Recurrences>2 weeks after the cessation of therapy nearly always represent reinfection with a new strain or with the previously infecting strain that has persisted in the vaginal and rectal flora.
In acute uncomplicated cystitis, more than 90 to 95% of infections are due to one of two organisms: E. coli or S. saprophyticus. Although resistance patterns vary geographically and resistance has increased in many areas, most strains are sensitive to many antibiotics. In most parts of the United States, more than one-quarter of E. coli strains causing acute cystitis are resistant to amoxicillin, sulfa drugs, and cephalexin, and resistance to trimethoprim (TMP) and trimethoprim-sulfamethoxazole (TMP-SMZ) is now approaching these levels as well.
A 3-day course of therapy withTMP-SMZ,TMP, norfloxacin, ciprofloxacin, or ofloxacin appears to preserve the low rate of side effects of single-dose therapy while improving efficacy; thus 3-day regimens are currently preferred for acute cystitis.

Evaluation by cystoscopy or intravenous pyelography is usually not warranted in all cases.

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