7 yr old girl with constant bladder infections

[Juli__0__0]

  Alixe is 7 and since January of 1997 she has had at least 10 bladder infections. We changed her wiping habits and increased fluid intake.  We successfully treated them with Bactrim for the first several months, then the doctor placed her on preventitive Bactrim (1 tsp. per day).  That worked for a few months, then she got a bladder infection while on the Bactrim.  If she happened to miss a dose, the symptoms would show up immediatly.  We've had the VCUG, IVP and ultra sound done, and everything was normal.  In the last 2 months, she was placed on Furadantin, but it either didn't work, or she had another infection within 5 days.  Now the doctor has just prescribed Keflex for a week before going back to the Bactrim.  Is there anything he's missing?  It seems no matter what we do, she keeps being reinfected.  Or is it that the infection is never really going away?  I would appreciate any advise that I could take with me to our next appointment 5/11.  Thanks ! Juli
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Dear Juli
Thanks  for  your question.  Sure look like your questions have generated alot of interest.
First to answer your question about incompletely treated infections.  The urine culture would grow the same bacteria again and again if the infection was never treated completely.  
If the test you mentioned were performed correctly and did not miss anything  (rare), your child does not have reflux and should not be at any increased risk of kidney  infections (pyelonephritis) and its complications.   If your child has had many bouts of fever > 101 with these UTI’s I would approach your doctor about repeating a nuclear cystogram.   She receives less radiation  and the test is more sensitive than a normal VCUG.  
Some people are at risk for urinary infections.  Once you have had one infection the lining of the bladder can not fight infections as effectively like when the bladder lining is healed. This is the rational behind prophylactic / preventative antibiotics, they give the lining a chance to heal.  Bubble baths probably irritate the urethra ( the urine tube ) and may increase the risk of bacterial adherence.  
It sounds like you are doing the appropriate thing to limit the number of infections.  Lots of fluids and frequent voiding can never hurt.    I might also  question  her bowel habits.   We find constipation is associated with UTI’s and therefore recommend a soft bowel movement once a day for children with this problem.   Laxatives like mineral oil can be messy but effective.  Increasing the fiber in the diet is a more natural way of staying regular.  
Most females notice a dramatic decrease in the number of infections when they enter puberty.
Hope this info has helped and good luck.
More individualized care is available at the Henry Ford Hospital and its urban campuses by calling  (1 800 653 6568). We can also arrange local accommodations through this number if this is your need. Please bring any physicians’ notes and lab test results that you  may be able to obtain. These will help us greatly.
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.
Sincerely;
HFHS-M.D. MS
* Keyword: UTI, reflux, vesicoureteral reflux