UTI management options increasing with ongoing research

NEW YORK — Previous research regarding urinary tract infection management is helping researchers come up with new options, according to a presenter here at the 26th Annual Infectious Diseases in Children Symposium.

Alejandro Hoberman, MD, who is chief of the division of general academic pediatrics at the University of Pittsburgh School of Medicine, reviewed previous studies; follow-up diagnostic imaging; management of vesicoureteral reflux (VUR); AAP UTI guidelines; and bladder and bowel dysfunction.

Alejandro Hoberman

Taking what has been shown in previous studies, including prevalence of UTI in febrile infants; validity of standard urinalysis; accuracy of dipstick urinalysis; and the distinction between UTI and asymptomatic bacteriuria, Hoberman said research underway is taking the next step to improving UTI diagnosis and treatment.

One new study, the Randomized Intervention for Children with vesicoureteral reflux (RIVUR), examined 607 children (46% girls) with about 91% already having their first UTI. At baseline, 56% of the 126 toilet-trained patients had bladder and bowel dysfunction. Four percent of patients had renal scarring at entry and most ultrasounds were normal. Five percent of children had hydronephrosis. Seventy-two percent of the normal ultrasounds were associated with grade 3 or 4 VUR. Only 5% of grade 3 and 22% of grade 4 VUR had hydronephrosis.

“It is important to note that most of the ultrasounds were normal,” Hoberman said during the presentation. “However, this is not a good test to identify children with reflux.”

Three new studies are being conducted to help determine more options for UTI management: Short Course Therapy for Urinary Tract Infections in Children (SCOUT), Biomarkers, and Steroids to Actively Reduce Renal Scarring (STAARS).

The SCOUT study will determine whether administering just 5 days of antibiotics vs. 10 days will result in fewer adverse outcomes.

The Biomarkers study will examine urine interleukins to determine whether there is a correlation of procalcitonin with dimercaptosuccinic acid renal scanning.

The last study, STAARS, will compare dexamethasone with placebo for 3 days plus antibiotics to check the 6-month outcome of dimercaptosuccinic acid renal scanning.

For more information:

Hoberman A. Presented at: IDC NY 2013; Nov. 16-17, 2013; New York.

Disclosure: Hoberman reports no relevant financial disclosures.