Frequent UTIs in 4 year old

[yellowbean]

My daughter has had 4 uti's within 12 months.... 3 of which have not cleared up after antibiotics and the last one was very bad and she was in hospital for 4 days. She was in a lot of pain with a fever of 40+ for over 5 days.... she has had an ultrasound scan on bladder and kidneys which showed nothing wrong and is being referred for another type of scan (one that uses a dye) in 6 months to check for kidney damage.

I'm not really getting much advice... mainly just being patronised.... A&E doc last night suggested that we think about long term preventative antibiotic use..... can anyone advise me on the pros and cons of this? and also.... i'd like her seen by a specialist... who would I be asking to be referred to? there is a history of kidney disease in the family so i dont want to ignore all this.
TIA xxx

If I were you I would ask GP to refer your DD to a urologist. Must be really worrying for you and really painful for DD.

What is being done already is exactly the right thing, directly following the nice guidelines. The preventative antibiotic is these days only prescribed if the ultrasound is abnormal, guidelines have changed in the past few years so the a&e doc is giving you out of date info. The scan in 6 months shouldn't be done any sooner or the results won't be accurate. I wouldn't suggest you be referred to anyone else unless this scan is abnormal as you are getting the gold standard treatment already and they won't do anything different as yet. It really isn't that uncommon for little girls to get frequent urine infections, 99% of the time they are not due to anything other than bad luck and not wiping very well and 99% of the time they cause no damage, the investigation pathway you are already on will safely ensure that your little one is not the 1% that may have problems

thanks sally... you're more reassuring than anyone else we've seen! what worries me though is that the uti's do not clear up after a standard course of antibiotics.... we were at a and e on friday because she was in pain again.... Also, she was sooooooo poorly this time......

If she gets one again should we get the same antibiotic? she was prescribed 2 others before the coamoxiclav this time and the delay in getting the right one into her really didnt help....

thanks

Bugs that cause urine infections are often resistant these days to the standard antibiotics we used to use, which I guess is why she didn't get the right one straight away. Generally, if I am seeing a child who has had a UTI in the past, I will check what antibiotics they were sensitive to last time and use that antibiotic again, so yes, is probably a good idea to start with the co-amoxiclav should she get another infection. I would also suggest, if it happens again, to make sure a urine sample is always sent to the lab so we know for certain we are using the right antibiotic.
It may be worth, once you have finished the current antibiotics, taking a sample in to the GP to be sent off to make sure it has been properly cleared.
General ways of reducing the risks of getting UTI's - drinking plenty, always wiping front to back, cotton knickers and no tights if possible and making sure she isn't constipated as large impacted stool in the rectum can stop the bladder from draining properly so increasing your risk of infection