Recurrent UTIs in a three year old

[dageris]

My 3 year daughter has had numerous UTIs since she was three months old.  A renal ultrasound and VCUG were perfomed about two year ago.  They demonstrated no problem.  Since then she has been affected by E-coli, proteus mellibilis, klebsiella among others.  Last year she received prophylaxis (Bactrim) to control the infections.  She was fine for six months while she was under treatment until Klebsiella gave her a new UTI while under prophylaxis.  She was given Augmentin.  However, she has been infected two more times for the last three months with the same bacteria.  Her pediatric Urologist mentioned to us that she may have to live with the fact that she will get UTIs for the rest of her life and we have to accept it.  Of course this is unacceptable to us, but we just do not know what else we can do to prevent UTIs.  The Urogist wants a new VCUG just in case there was no mistake in the first one.  We are struggling with this idea since VCUGs are usually very reliable.  Can you comment on this second VCUG?

The Urologist wants also a new renal ultrasound, which we agree.

We are gathering information on Probiotics.  We are just starting to give her 2 daily tablets containing Lactobacillus acidophilus tablets that contain 1 billion organisms each.  However, since she is under constant antibiotic treatment, I am afraid we are killing the good bacteria that we are trying to maintain in her system.  

Can you comment on Probitics as far as the bacteria (Lactobacillus) that is most appropriate for UTIs.  How does oral tablets reach the bladder?  Does the bacteria has to be introduced through suppositories or are oral tablets fine in your opinion.  And, are we killing the bacteria we are giving her so its useless to give her the tablets under antibiotic treatment?

We are also looking at immunotherapy.  I read on several articles that low immunoglobin count in the bladder can also be the cause of recurrent UTIs.  We want to start giving my daughter Pidotimod (Adimod)to increase her immune response.  This medicine can be given under the supervision of a Mexican doctor.  If you suggest immunotherapy, but you are not so accepting of traveling to Mexico for this, then what doctors can provide this immunotherapy.  Her Urologist is totally opposed to this treatment so we can not count on her.  What do you suggest as far as immunotherapy?

Please comment on anything that I may have missed.  I am trying to cover all the possibile causes.  Please comment on the 2nd VCUG.  Thank you.

[Kevin Pho, MD]

Normally, VCUGs are accurate in diagnosing VUR.  Another diagnostic test would be a radionuclide cystogram (RNC), which sometimes may detect cases not seen on a VCUG.  

That being said, you want to ensure there is no VUR, so either repeating the VCUG or obtaining an RNC can both be considered.

Normally, cases of refractory UTIs can be treated with long-term prophylactic antibiotics - if Bactrim is not effective, you can consider Macrobid.  This can be discussed with your urologist.

I am not aware of data suggesting efficacy of probiotics in cases of recurrent UTI.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_b

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