Adolescent urinary tract infections.

Urinary symptoms in adolescents are common, particularly in females. Urinary tract infections (UTIs) cause many of these symptoms. For uncomplicated UTIs, both lower and upper tract, therapy is straightforward. Commonly used antibiotics are trimethoprim/sulfamethoxazole (TMP/SMX), cefixime, and ciprofloxacin (off-label use) for 3 days for lower tract infections and 10ñ14 days for upper tract infections. Adolescent UTIs are markers for sexual activity, just as UTIs in younger children are often markers for anatomic defects, e.g., congenital abnormalities. Adolescents with upper and lower UTIs often have concurrent sexual activity or a complication of that activity. Issues among adolescents with UTIs are more similar to those of young adults than to those of younger children. It is as important to counsel adolescents about sexual activity and its consequences as it is to treat the UTIs. All adolescents with UTIs should be queried for sexual activity; evidence of sexually transmitted diseases (STDs) should be sought; and counseling for STDs and responsible sexual activity is recommended. Complicated UTIs include those in patients who have grown into adolescence after a childhood of infections or who have anatomic abnormalities, recurrent infections, reflux and reflux nephropathy, spina bifida and neurogenic bladder, transplanted kidneys, diabetes, and urolithiasis. These patients require individualized medical programs, unique for their condition, history, and microbiology.