Urinary Infections

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HealthWiki > Disabled Village Children > Chapter 25: Urine and Bowel Management > Urinary Infections

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In this chapter:

 

In this chapter:

Persons with spinal cord injury or spina bifida have a high risk of urinary (bladder) infections, for the reasons we have discussed. Long-term or untreated infections and kidney problems are a common cause of early death. Preventive measures are essential (see the below); but even when precautions are taken, some urinary infections are still likely to happen. Therefore, it is very important to recognize the signs and provide effective treatment.

Signs

When a person without a spinal cord injury has a urinary infection, it often burns when he pees. The person with spinal cord injury may not feel this burning and therefore has to use other signs to know when he has an infection. He may learn to recognize certain unpleasant feelings, or may only know that he does not feel as healthy as usual. Parents and health workers should learn to listen to the child and be aware of changes in behavior or other signs that might mean that he has an infection.

Possible urinary signs cloudy urine, possibly with pieces of mucus, pus, or blood specks dark or red urine strong or bad smelling urine increased bladder spasms (cramps) increased wetting or changes in bladder function pain in the mid-back (kidneys) or side (urine tubes)

Possible other signs body aches general discomfort increased muscle spasms fever dysreflexia (headache, goosebumps when sweating, high blood pressure)

Treatment

At the first signs of infection, drink even more water than usual. Antibiotics (medicines that fight bacteria) may also be necessary. But avoid frequent use of antibiotics because they may become less effective (bacteria may become resistant).

If a person has had many urinary infections before, take the person to a medical laboratory for a culture and sensitivity test of the urine. If possible, consult a specialist in urinary problems. If this is not possible, start with the last medicine that was effective.

In patients with a first infection:

• Start with one of the medicines in in Group 1 below. After 2 days, if the person does not begin to improve, try another medicine in Group 1.
• If none of the medicines of Group 1 help, try the medicine in Group 2.
• If a medicine seems to help, continue taking it for at least a week, or for 3 days after the last signs have disappeared. Do not change from one medicine to another unless the medicine is not working or causes serious side effects.

TREATMENT FOR URINARY INFECTIONS
GROUP 1
Medical name (and brand name)	Age	Dose	How to take	Cautions
A. Co-trimoxazole = sulfamethoxazole (SMX) + trimethoprim (TMP) (Bactrim, Septra)	2 to 5 months	120 mg (100 mg SMX + 20 mg TMP)	By mouth, 2 times a day for 7 days	This medicine can cause kidney damage unless the person drinks lots of water. Bacterial resistance to this drug has increased in some places. If symptoms do not improve after 2 days of treatment, choose a different Group 1 medicine.
	6 months to 5 years	240 mg (200 mg SMX + 40 mg TMP)
	6 to 8 years	480 mg (400 mg SMX + 80 mg TMP)
	9 years and older	960 mg (800 mg SMX + 160 mg TMP)
B. Amoxicillin + clavulanic acid (Augmentin)	under 1 year	31.25 mg amoxicillin/kg + 7.5 mg clavulanic acid/kg	By mouth, 3 times a day for 7 days	Do not use for persons allergic to penicillin. In many places, bacteria that cause urinary infections are resistant to amoxicillin alone. If you do not have amoxicillin + clavulanic acid, choose a different Group 1 medicine.
	1 to 5 years	125 mg amoxicillin + 31.25 mg clavulanic acid
	6 to 11 years	250 mg amoxicillin + 62.5 mg clavulanic acid
	12 to 17 years	250 mg amoxicillin + 125 mg clavulanic acid
C. Nitrofurantoin (Furadantin, Macrodantin) (from 3 months: 5 to 7 mg/kg/day)	2 months to 3 years	12.5 mg	By mouth, 4 times a day for 7 days
	3 to 8 years	25 mg
	8 to 15 years	50 mg
	15 years and older	50-100 mg
GROUP 2
Cephalexin (Keflex) (25 to 50 mg/kg/day)	3 to 11 months	125 mg, 2 times a day	By mouth, for 7 days
	1 to 4 years	125 mg, 3 times a day
	5 to 11 years	250 mg, 3 times a day
	12 to 15 years	500 mg, 3 times a day
Cefixime (Suprax)	under 1 year	40 mg	By mouth, 1 time a day for 7 days
	1 to 3 years	65 mg
	4 to 7 years	120 mg
	8 to 13 years	240 mg
	over 13 years	480 mg

PREVENTION OF URINARY INFECTIONS

To prevent urinary infections, drink
LOTS OF WATER

• Drink lots of liquid: adults, at least 2 liters (8 glasses) a day.
• Eat apples, grapes, or cranberries or drink their juices or take vitamin C tablets to make urine more acid. Bacteria grow with more difficulty in acid urine. Note: Orange or lemon juice and other citrus fruits and juices do not work! They make the urine less acid.
• Keep hands, catheter, and collection bags very clean before, during, and after your bladder program.
• Do not lie in bed all day. Stay active.
• Do not clamp the Foley catheter or plug it with anything unless absolutely necessary, then use a sterile plug.
• Stick to your bladder program. Do not allow urine to sit in bladder.
• Do not let the catheter get bent or twisted so that urine cannot come out.
• If using a standard catheter periodically, be sure to put it in regularly, at least every 4 to 6 hours. To prevent infections, frequency of catheter use is even more important than cleanliness. It is safer to put in the catheter without boiling it than not to put it in. If infections are common, catheterize more often.

This page was updated:25 Nov 2024