[Therapy of lower urinary tract infections in children]. / Terapia delle infezioni delle basse vie urinarie nel bambino.

Infection of the urinary tract has been described for nearly two centuries, yet the diagnosis, localization of infection, outcome, and management of UTI continue to generate significant problems. The two basic aims of treatment of UTI are the relief of symptoms and the prevention, or at least limitation, of damage to the renal parenchyma. The initial choice of an antimicrobial in the patient with a suspected UTI is based on knowledge of the expected organisms and their antimicrobial susceptibilities. The spectrum of urinary pathogens and their antibiotic susceptibility patterns in our geographical area are presented. Moreover therapeutic regimens in the treatment of upper and lower UTI are discussed.

[Criteria for selecting antibacterial drugs for use in newborn infants]. / Criteri di scelta dei farmaci antibatterici in età neonatale.

During the last years many advancements have been made in the field of clinical pharmacology. Nowadays we have a better understanding of the factors influencing absorption, distribution and elimination of antibacterial drugs in the newborn. However many problems have not been faced yet; of primary importance are earliness and aiming of therapy. Much has been written about the use of hematologic screening tests for an early diagnosis of sepsis and the use of tests for a rapid etiologic diagnosis. This is probably the result not only of the commonly encountered difficulty in making a clinical diagnosis of sepsis (based on clinical findings that are often insidious and aspecific) but also of the implications concerning either a "non-diagnosis" or a large use of antibacterial drugs. The choice of an appropriate antibacterial therapy in the newborn with sepsis implies a careful interpretation of the data concerning: 1) bacterial epidemiology and 2) sensitivity towards drugs of the bacterial most commonly identified in sepsis. For that purpose, it is important to distinguish between early and late sepsis and between the etiological agents more frequently responsible for the first and those for the later. Moreover it is important to consider the role of rapid tests in the etiological diagnosis, as a guide to the modification of the initial empirical therapy.

Correlation between dosage and antipyretic effect of aspirin in children.

One hundred and forty-five children aged 3 months to 11.5 years, with rectal temperatures greater than 38.9 degrees C, were randomly treated with aspirin 5, 10 or 15 mg/kg p.o. Temperatures were recorded just before medication, every 30 min thereafter for 4 h and subsequently hourly up to 6 h. In all dosage regimens the average temperature was significantly reduced in the time interval 1-6 h after drug administration; the antipyretic effect, however, was significantly greater with the 10 and 15 mg/kg doses. Both had significantly better and comparable clinical efficacy, defined as reduction in fever below 38.9 degrees C. The duration of the clinical effect was not dose-related. A dose of 10 mg/kg appears rational for the treatment of children with fever.

Single-dose netilmicin therapy of complicated and uncomplicated lower urinary tract infections in children.

Thirty children (age 3 months to 10 years) with complicated and uncomplicated lower urinary tract infections were treated with a single intramuscular injection of netilmicin 4.5 mg/kg. The diagnosis of lower urinary tract infection was based on the absence of fever and the presence of normal values for erythrocyte sedimentation rate, C-reactive protein concentration and urinary excretion of N-acetyl-beta-D-glucosaminidase. Follow-up urine cultures in all children demonstrated a cure rate of 97% and reinfection and relapse rates each of 7% respectively. The subgroup (12 children) with radiological abnormalities of urinary tract showed a cure rate of 92%, and reinfection and relapse rates of 9% respectively. The rates of cure, reinfection and relapse in the complicated and uncomplicated urinary tract infections were not statistically different (p greater than 0.05). A pharmacokinetic study (performed in 5 children) demonstrated that netilmicin urinary concentrations were over the MIC's of the infecting organisms up to 96 hours after the single-dose injection. Netilmicin was well tolerated and no side effects appeared during treatment. Single-dose netilmicin therapy is an effective and safe regimen for complicated and uncomplicated urinary tract infections in children. The response to single-dose netilmicin therapy seems to be related to its prolonged urinary elimination.

Early and late neutropenia in children treated with cotrimoxazole (trimethoprim-sulfamethoxazole).

The incidence of hematologic abnormalities was evaluated in 120 children with otitis media treated respectively with cotrimoxazole (trimethoprim-sulfamethoxazole) (group 1), cotrimoxazole plus folinic acid (group 2) and amoxicillin (group 3) in therapeutic doses for ten days. Only eosinophilia (an absolute count greater than or equal to 0.5 X 10(9)/l) (group 1 = 10%, 2 = 5%, 3 = 7.5%) and neutropenia (polymorphonuclear neutrophilic leucocyte count less than or equal to 1.5 X 10(9)/l) (group 1 = 35%, 2 = 17.5%, 3 = 13.3%) were noted. Early neutropenia (evident on the 5th day of therapy) occurred in all the treatment groups, thus it is not related to cotrimoxazole administration and in most cases neutrophil count reversed to normal in few days without drug discontinuation. Late neutropenia (evident after 10 days of treatment) appeared only in cotrimoxazole treated children (p less than 0.05). No superimposed bacterial infection was demonstrated in any case. Late neutropenia seems to be strictly related to the sequential blockage of folinic acid metabolism and can be prevented by the concomitant administration of folinic acid.

N-acetyl-beta-D-glucosaminidase (NAG) and NAG isoenzymes in children with upper and lower urinary tract infections.

The use of N-acetyl-beta-D-glucosaminidase (NAG) to diagnose the site of urinary tract infection was studied in pediatric patients. Differentiation between upper and lower tract infections (UTI) was based on clinical grounds and on elevated erythrocyte sedimentation rate, C-reactive protein and fever. NAG excretion expressed as nmol X h-1 X mg-1 of urinary creatinine was higher in children with upper UTI (mean +/- SE 906 +/- 236) than in those with lower UTI (145 +/- 23) or healthy children (151.6 +/- 10) (p less than 0.01 by Duncan's test). In children with upper UTI, NAG excretion fell in parallel with the remission due to antibiotic treatment. This however was not seen in children treated with aminoglycosides. A specific and significant elevation (p less than 0.01) of the B isoenzyme of NAG was documented in children with upper UTI but not in those with lower UTI (B form in upper UTI 49.2% +/- 3.9 versus 21.9 +/- 3.3 in lower UTI; healthy children 18.9 +/- 3.4). The percentage of B isoenzyme excreted was high in two children with upper UTI but was low total NAG urinary excretion, suggesting that the quantification of isoenzymes offers further specificity in diagnosis. We conclude that the measurement of NAG and its isoenzymes in children with UTI provides useful information in the diagnosis of the site of infection.