Optimization of the system of observation of children with urinary tract infection under the conditions of antibiotic resistance
Keywords:
urinary tract infection, children, antibiotic resistance, surveillance systemAbstract
Algorithms for the diagnosis and treatment of urinary tract infections (UTIs) in children need to be revised and optimized according to current disease trends and new diagnostic capabilities.The aim. To develop a modern diagnostic and treatment system for monitoring children with UTI at different stages of the disease.
Materials and methods. The study included 2754 children with ISS aged 0 to 18 years in the period 2009–2019. Among the patients were outpatients and hospital patients at different stages of UTI. The examination of all patients and the evaluation of the obtained data were carried out with the informed consent of children, their parents and in accordance with the Helsinki Declaration of Human Rights.
Results. We determined that patients with an outpatient plan of 12–18 years with suspected UTI (who do not have fever and other signs of systemic inflammatory reaction) should apply the tactics of delayed ABT based on the results of a negative dipstic test, the appointment of herbal medicine and the possibility of ABT for 3 day of observation if necessary. ABT of empirical choice in the treatment of uncomplicated ISS in children >3 years may be furazidin K (the level of resistance of Escherichia coli in 2019 — 8.0%±21.07). The drug of choice in the treatment of pyelonephritis — ceftazidime (resistance at 14.3%±15.15), in multidrug&resistant conditions and vital signs — ciprofloxacin (resistance — 11.0%±17.5). Urivac multicomponent vaccine therapy is recommended for children >7 years of age with recurrent UTI. Uriclar phytocitrate should be included in the treatment of UTI on the background of mineral disorders in children from 6 years of age with subsequent administration of the drug to prevent reinfection in intermittent mode from 2 months.
Conclusions. The use of the proposed diagnostic and treatment system for monitoring children with UTI will contribute to the rational therapy and prevention of recurrent episodes.
No conflict of interest was declared by the author.
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