Bensman Albert, Ulinski Tim
Service de Néphrologie Pédiatrique, Hôpital d'Enfants Armand Trousseau (APHP), 75012 Paris, France.
Expert Opin Pharmacother. 2009 Sep;10(13):2075-80. doi: 10.1517/14656560903095273.
This review focuses on the treatment of urinary tract infections (UTI) in children. Acute pyelonephritis (an infection involving the renal parenchyma), acute cystitis (infection limited to the lower urinary tract) and asymptomatic bacteriuria (absence of clinical symptoms) have to be clearly distinguished. Whereas antibiotics are needed in pyelonephritis and cystitis, they should be used only exceptionally in cases of asymptomatic bacteriuria, as they may be potentially harmful and select more virulent bacteria. In case of pyelonephritis, there should be no delay in beginning the treatment in order to decrease the risk of long term complication in particular renal scars. Predisposing conditions for UTI should be evaluated carefully. New concepts concerning analysis of virulence profile or specific host immune response might bring more comprehension to UTI, but yet these concepts do not influence clinical practice. Any recommendation about (initial) antibiotic treatment should be regularly updated and adapted to local resistance profiles and to economical factors in different health systems.
本综述聚焦于儿童尿路感染（UTI）的治疗。必须明确区分急性肾盂肾炎（一种累及肾实质的感染）、急性膀胱炎（局限于下尿路的感染）和无症状菌尿（无临床症状）。肾盂肾炎和膀胱炎需要使用抗生素，但无症状菌尿仅在特殊情况下使用，因为抗生素可能有潜在危害并筛选出更具毒性的细菌。对于肾盂肾炎，应立即开始治疗以降低长期并发症尤其是肾瘢痕的风险。应仔细评估UTI的易感因素。关于毒力谱分析或特定宿主免疫反应的新概念可能会增进对UTI的理解，但这些概念尚未影响临床实践。关于（初始）抗生素治疗的任何建议都应定期更新，并根据不同卫生系统的当地耐药情况和经济因素进行调整。
