Prolonged Maintenance Chemotherapy in the Management of Urinary Infection in Childhood

Abstract

One hundred and sixteen children with urinary infections have been treated with continuous maintenance chemotherapy for periods of six months to seven years, using sulphonamides in most of them. The children were seen and their urine was examined at regular intervals, not exceeding three months, throughout treatment. The number of attacks of urinary infection before the start of this treatment was assessed from the history and compared with the incidence of bacteriological recurrences during therapy. In 50 children with normal radiological investigations there were only four recurrences during a 6- to 12-month period of treatment, although there were recurrences in 6 out of 20 children after completion of their treatment. In 66 children shown to have radiological abnormalities, maintenance chemotherapy reduced the incidence of infection from an average of approximately 2.5 attacks per patient per annum before treatment to approximately 0.3 recurrence per patient per annum. This group included 46 children with vesico-ureteric reflux and 20 with radiological chronic pyelonephritis, these conditions coinciding in 18. The potential value of long-term chemotherapy in the prevention of renal damage is discussed. We should like to express our thanks to Dr. B. E. Schlesinger, Dr. R. E. Bonham Carter, and Dr. L. B. Strang for permission to study and treat patients under their care; to Mr. D. R. Davies and Mr. D. Innes Williams for kindly allowing us to follow and treat the children treated surgically; to Dr. C. J. Hodson and Dr. D. Edwards for the radiological studies upon which much of the work is based; to Dr. E. Joan Stokes and her department for the bacteriological studies; to Sister M. Curtis and Sister M. Whitechurch, of the Children's Department U.C.H., for their unfailing help in the Urinary Infection Clinic; and to all of these and to Professor M. L. Rosenheim for their continued advice, help, and encouragement. © 1965, British Medical Journal Publishing Group. All rights reserved.