Management of urinary tract infection and vesico-ureteric reflux in children.

Even though urinary tract infection is common in childhood, its diagnosis and management can be difficult. One must be aware of factors that may interfere with urine culture result. Besides urinary stasis, renal tract abnormalities and detrusor instability, host factors and certain strains of invading organisms (P-fimbriated E Coli) may be important in the pathogenesis of urinary trace infection. The choice of antibiotics for treatment of urinary tract infection should be guided by the age of the patient, clinical presentation and urine culture result. The management of vesico-ureteric reflux depends on its grading. Grade I and II can be treated medically by long-term low dose antibiotics because spontaneous resolution is high. For Grade III and IV, the treatment of choice is controversial. Controlled prospective studies showed that surgical reimplantation did not prevent new scar formation, progression of old scars and breakthrough infection. Endoscopic submeteric injection of Teflon is a new method to correct vesico-ureteric reflux. Despite favourable short-term results, the long-term outcome is unknown.