Untreated asymptomatic bacteriuria in girls: II--Effect of phenoxymethylpenicillin and erythromycin given for intercurrent infections.

OBJECTIVE

To investigate the effects of phenoxymethylpenicillin and erythromycin on urinary isolates from patients with untreated asymptomatic bacteriuria.

DESIGN

Retrospective study of subgroup of patients from cohort followed up till the end of 1986.

SETTING

Outpatient clinic for children with urinary tract infections.

PATIENTS

51 Girls aged under 15 with untreated asymptomatic bacteriuria.

INTERVENTIONS

Before 1982 intercurrent infections (mostly tonsillitis or otitis) were treated with phenoxymethylpenicillin; after 1982 erythromycin treatment was preferred.

END POINTS

Change of bacterial strain in urinary tract and symptomatic recurrences of disease.

MEASUREMENTS AND MAIN RESULTS

Bacteria identified by serotype and electrophoretic type and compared before and after antibiotic treatment. Bacteriuria eradicated and replaced by new strains in most patients treated with phenoxymethylpenicillin, leading to symptomatic recurrences in about 15%. Conversely, patients given erythromycin rarely showed change in bacteriuria and none suffered symptomatic recurrence.

CONCLUSIONS

In girls with untreated asymptomatic bacteriuria the use of phenoxymethylpenicillin for intercurrent infections may lead to a change of urinary bacteria and leave them at substantial risk of acute pyelonephritis. With erythromycin this risk is small (2/20 courses in this series).