Within a period of 12-24 hours, oral therapy may be started, depending on the response. The optimal duration of treatment of acute uncomplicated UTI is controversial. There are several randomized, controlled studies using short course antimicrobials in children. Conventional therapy ranges from 7 to 10 days, however young children with first time infection should continue to receive low-dose antimicrobial prophylaxis and until radiographic evaluation is completed. Antimicrobials proved effective in prevention of recurrent UTIs include co-trimoxazole or nitrofurantoin.
Prophylactic doses are generally less than used to treat acute infection.
One third or one half of the therapeutic dose once at bedtime is usually effective to prevent recurrent infection. The duration of prophylactic therapy is variable, but at least in those children with VUR, treatment is generally continued till reflux either disappears or till surgery is performed for the same. Other indications for surgery also exist but this issue is beyond the scope of this article. The decision is best taken after a complete evaluation by the surgeon. Several studies have shown that the incidence of UTI in uncircumcised boys is higher than in circumcised boys.