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Introduction Introduction
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Causes of ill health Causes of ill health
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Motion sickness Motion sickness
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Immunization and prophylaxis Immunization and prophylaxis
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Malaria Malaria
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Diarrhoeal disease Diarrhoeal disease
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Skin infections Skin infections
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Atopic conditions Atopic conditions
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High-risk travellers High-risk travellers
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HIV-infected children HIV-infected children
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Children with cancer Children with cancer
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Transplant recipients Transplant recipients
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Post-splenectomy patients Post-splenectomy patients
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Antibody-deficient children Antibody-deficient children
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Drug interactions Drug interactions
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First-aid kits First-aid kits
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Suggested minimal kit Suggested minimal kit
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Future research Future research
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Further reading Further reading
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Cite
Abstract
Urinary tract infection (UTI) is the commonest serious bacterial infection in childhood, affecting 11.3% of girls and 3.6% of boys under 16 years. UTI is defined as significant bacteriuria in the presence of symptoms. Gut coliforms are the responsible organisms, and disease severity depends on bacterial virulence and host susceptibility factors, ranging from mild cystitis to severe pyelonephritis. Prompt diagnosis and antibiotic treatment are important for a quick and uncomplicated recovery, which is the case for the majority of affected children. Diagnosis remains challenging for young, not toilet-trained children due to non-specific clinical presentation and practical difficulties in appropriate urine sample collection. Oral antibiotics are well effective, and long intravenous regimens are only exceptionally necessary beyond the neonatal period. Local sensitivity data are important to guide antibiotic policies in the face of increasing resistance of uropathogens. Non-antibiotic adjunctive therapy, such as steroids, vitamin A, and probiotics, have been reported to be beneficial. The subsequent management of children with UTI has for long been controversial. The long-term consequences of UTI and the associated policies of extensive imaging and routine prophylactic antibiotics are currently being questioned. Although, in a significant number of children with UTI, an underlying urological abnormality is present, more commonly vesicoureteral reflux, its detection is of little importance for further management or long-term outcome. Current guidelines for UTI management emphasize a prompt diagnosis, call for significant imaging reduction, and discourage the routine use of prophylaxis, pointing to a patient-tailored policy in the near future.
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