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Cytokines play a major role in renal scar formation following febrile urinary tract infection (UTI). We investigated the role of dexamethasone combined with antibiotics in diminishing urinary interleukin-6 (UIL-6) and UIL-8 concentrations during the acute phase of pyelonephritis compared with standard antibiotic therapy. UIL-6 and UIL-8 concentrations were determined by enzyme immunoassay in 34 children with pyelonephritis who were treated with ceftriaxone plus dexamethasone (case group) and in 20 patients with the same diagnosis treated with ceftriaxone alone (control group). Urine samples were obtained at the time of presentation prior to drug administration and at follow-up 72 h after initiation of medication. Creatinine concentrations were also determined, and cytokine/creatinine ratios were calculated to standardize samples. Differences between cytokine/creatinine ratios in initial and follow-up urine samples were significant in the case group (P < 0.001) but not for controls. In addition, combined antibiotic and dexamethasone significantly decreased UIL-6 and UIL-8 concentrations compared with antibiotic alone (P < 0.05). We conclude that dexamethasone combined with antibiotics significantly decreases UIL-6 and UIL-8 levels in patients with acute pyelonephritis. This suggests that the clinical use of corticosteroids may prevent scar formation following febrile UTI.

Urinary tract infection is one of the most common diseases in children. Early diagnosis and comprehensive treatment can significantly decrease late serious complications. Knowledge of the sensitivity and resistance pattern of uropathogens in specific geographical locations is an important factor for choosing suitable antibacterial treatment. This study was conducted in order to evaluate the antibacterial resistance of urinary pathogens at Mofid Children's Hospital between March 2000 and August 2001. Positive urine cultures from 1,177 children aged less than 12 years (mean age, 31.7 months; female to male ratio, 2:1) were studied. Cultures were performed on urine samples obtained by sterile urine bags in infants and midstream urine in older children; if samples were contaminated then a suprapubic sample was taken in infants. Sensitivity was measured by the disc diffusion method using the NCCLS protocol. The most prevalent urinary pathogen was Escherichia coli (666 cases, 56.6%). Overall, the lowest resistance rate of microorganisms was that against ciprofloxacin (6.7%) and the highest resistance rate was that against penicillin (83%). A comparison of these data with those of other countries shows that there is considerable geographic variation in bacterial patterns of sensitivity and resistance properties. Therefore, the selection of antibiotics for empiric therapy should be based on the sensitivity and resistance pattern of uropathogens in the respective city.