Controversy in urinary tract infection management in children: a review of new data and subsequent changes in guidelines.

Abstract

Controversy and lack of consensus have been encountered in the management of pediatric urinary tract infection (UTI), including its diagnosis, radiological investigations and the use of antibiotic therapy. In this review, we discuss the need for radiological investigations and the extent of their use as well as the need for prophylactic antibiotics in children with UTI and vesicoureteral reflux. Only a small proportion of children with first UTI and no history of antenatal renal abnormalities have clinically important malformations. Renal ultrasound should be performed in febrile infants and young children with UTI; a micturating cystourethrogram should not be performed routinely after the first febrile UTI. Long-term antibiotics appear to reduce the risk of recurrent symptomatic UTI in susceptible children, although the clinical benefit is marginal. Current recommendations encourage performing radiological investigations only in children at risk and discourage routine prophylactic antibiotic use.

• Authors: Jameela Abdulaziz Kari, Kjell Tullus
• Journal: Journal of tropical pediatrics (J Trop Pediatr) Vol. 59 Issue 6 Pg. 465-9 (Dec 2013) ISSN: 1465-3664 [Electronic] England
• PMID: 23812014 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (therapeutic use)
• Antibiotic Prophylaxis
• Fever (drug therapy, etiology)
• Humans
• Infant
• Practice Guidelines as Topic
• Secondary Prevention
• Ultrasonography
• Urinary Tract (diagnostic imaging)
• Urinary Tract Infections (diagnosis, drug therapy, prevention & control)
• Urography (adverse effects)
• Vesico-Ureteral Reflux (diagnosis, drug therapy, prevention & control)