[cactus1972]

Обновленные рекомендации ААР по лечению ИМП у детей в возрасте 2-24 месяцев

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Основные положения гайдлайна

•Compared with parenteral therapy, oral antimicrobial therapy is as effective in treating UTI.
•Evidence from published, randomized controlled trials suggests that when voiding cystourethrography (VCUG) shows vesicoureteral reflux (VUR), antimicrobial prophylaxis is not recommended to prevent febrile UTI.
•The sensitivity of urinary tract ultrasonography after the first UTI is poor.
•The risk for renal damage from UTI may be reduced by early antimicrobial therapy.

•Diagnosis of UTI is made from an appropriately collected urine specimen based on the presence of pyuria as well as 50,000 colonies per mL or more of a single uropathogenic organism.
•To facilitate prompt diagnosis and treatment of recurrent UTIs, close clinical follow-up monitoring should be maintained after 7 to 14 days of antimicrobial therapy.
•To diagnose anatomic abnormalities, ultrasonography of the kidneys and bladder should be performed.
•Because evidence from the most recent 6 studies does not support the use of antimicrobial prophylaxis to prevent febrile recurrent UTI in infants without VUR or with grade 1 to 4 VUR, VCUG is not recommended routinely after the first UTI.
•However, VCUG is indicated if renal and bladder ultrasonography results show hydronephrosis, scarring, or other evidence of high-grade VUR or obstructive uropathy, as well as in other atypical or complex clinical circumstances.
•Infants and children who have recurrence of a febrile UTI should also undergo VCUG.