Question Title: Recurring Bladder Infections

My 7 year old daughter is having recurring bladder infections. This has been happening for 5 years, coincidentally after falling and rupturing her hyman. She has been on several different antibiotics and her body has built a resistance to them or she has developed an allergic reaction to them. Her physician is at a loss as to what to do. At this point he wants to admit her to the hospital and do IV antibiotics but he says this will not cure it only hopefully prolong until the next infection. I realize little girls are prone to bladder infection and she previously had Reflux but they have since said she outgrew it but the infection still keep coming. She can only be off antibiotics about 7 days before getting another although the one she has now she was still on antibiotics (Furadantin). This is the second infection on this one. What can we do for her? What should our doctor check for or what is the next step for us? Thank you.

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Dear Lisa:

Urinary tract infections (UTI) are more common in girls than boys. The combination of UTIs and reflux, however, can be dangerous in children due to the reflux of infected urine into the kidneys that leads to pyelonephritis. Pyelonephritis is particularly a problem in children because in the process of healing the involved portion of the kidney scars and leads to nonfunction of that segment Because children’s kidneys are not fully developed, they can only take several “hits” of pyelonephritis before developing possible renal failure from recurrent scarring. In adults however, this is not a concern since the kidneys have undergone maturation. Therefore, for low grade reflux, the child is observed, since many of these cases improve with time (growing up), and kept on prophylactic antibiotics to prevent urinary tract infections in the presence of known reflux. In cases where the reflux is severe at time of detection, getting worse with time, or not improving with observation, ureteral reimplantation (an operation) is performed.

You mention that your daughter has now outgrown the reflux, but has been experiencing recurrent UTIs since age 2 (five years ago) when she ruptured her hymen after a fall. I can not comment on the relevance of a ruptured hymen and UTIs because such data is not available, and perhaps the two are not necessarily related, but coincidentally related. However, the current data suggests that some women are more susceptible to bladder infections than other females due to an increased affinity of their bladder mucosa for adherence of bacteria to them. Bacteria may enter the bladder, and in fact trace amounts of bacteria can be found in many women’s bladders. However, this does not mean that they will necessarily suffer from a “Bladder Infection” with all the symptoms and sequelea associated with it. On the other hand, if one’s bladder mucosa (for some unknown reason as of date) is more susceptible to UTIs, they will continue to recur and will require symptomatic treatment or prophylactic antibiotics to prevent them in the first place. However, one needs to work up the child for any possible infectious stones in the urinary tract that may be the cause, or any other anatomical abnormality that may be responsible. At this point, you may need to take your daughter to a pediatric urologist (or general urologist who feels comfortable with working up and treating children) to rule out any other possible causes for recurrent UTI, and to make the appropriate recommendations based on her specific problem. I wish you the best, and hope that the information is useful to you.

This information is provided for general medical education purposes only. Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition. More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).

Sincerely,
HFHS M.D.-JJ
*Keyword: Recurrent UTI, ureteral reflux,

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