Prevention of Recurrent Urinary Tract Infections in Girls

Death from chronic pyelonephritis of several girls with otherwise normal urinary tracts has focused our attention on the importance of controlling bacterial infections of the kidney. At the same time, difficulties encountered in the management of kidney infections were emphasized by the stormy courses of six girls with frequently recurring pyelonephritis. Although these children had anatomically normal urinary tracts and each infection could be eradicated by appropriate therapy utilizing information gained from urine cultures and sensitivity studies, reinfection invariably followed. Prior to referral, several therapeutic approaches had been tried without achieving permanent remission, including one month of hospitalization for treatment with massive doses of antibiotic combinations. Finally, a program was instituted for the purpose of preventing recurrences.¹ After the infections had been cleared by appropriate antibacterial drugs, the patient was started on methenamine mandelate and, when indicated, a urinary acidifying agent. This paper describes this prophylactic program and its