STUDIES OF URINARY TRACT INFECTIONS IN INFANCY AND CHILDHOOD X. Short or Long-term Treatment in Girls with First or Second-time Urinary Tract Infections Uncomplicated by Obstructive Urological Abnormalities

The aim of the present investigation, concerned with 279 girls with their first-time, or in a few cases second-time urinary tract infection, was to explore the possibility to improve the “1-year cure rate” by means of long-term sulfonamide therapy (2 months) instead of short-term sulfonamide therapy (10 days). A “1-year cure” was then defined as an eradication of the index infection and freedom from infection during the following year. The “1-year cure rate” was found to be equal in the two therapy groups i. e. 64 per cent. The material showed some characteristics which might permit some general statements about uncomplicated first or second-time urinary tract infections in girls. The material showed a marked predominance of the younger age groups. This finding is discussed with regard to the pathogenesis of urinary tract infection. The bacteria isolated at the initial infections were in 90 percent E. coli and also in 90 per cent sensitive to sulfonamide. Thus for the present there is no reason to abandon sulfonamide as the drug of choice in uncomplicated first-time infections in girls. The first recurrence had a tendency to appear shortly after the original infection rather than late. Observations suggest that recurrences, even those occurring immediately after cessation of therapy, were usually a reinfection and not a recrudescence. These findings are discussed in relation to the pathogenesis of recurrent urinary tract infections. The first recurrence was in 1/3 of the cases asymptomatic, in the other 2/3 symptomatic. During long term prophylaxis asymptomatic infections even outnumbered the symptomatic ones. Therapy thus may mask an infection. The bacteria isolated at the first recurrences after the index infection were in 30–90 per cent resistant to sulfonamide, the rate being related to the time interval between the cessation of therapy and the recurrence. The therapeutic consequences of the difference in sulfonamide sensitivity of the initial infection and the recurrences are discussed.