Urinary Tract Infection in Children

Urinary tract infections (UTI) are common among children. In the past 20 years, a number of key trials have substantially changed practice, in addition to clarifying the natural history of children managed expectantly. It is now clear that among children with normal kidneys at presentation, chronic kidney disease and hypertension are rare. Improved antenatal ultrasound now detects most significant abnormalities of the kidney and urinary tract, particularly severe hypodysplasia, which is often associated with high-grade vesico-ureteric reflux (VUR). This review aims to summarize the evidence-based treatment of UTI in children. There is no difference in symptomatic, microbiologic, or renal outcomes between intravenous and oral antibiotics in treating acute, febrile infection. Long-term antibiotic prophylaxis results in a statistically but not clinically significant reduction in recurrence among young children, with or without VUR. Trials to-date have failed to demonstrate that the surgical correction of VUR confers any additional benefit, which may be because the natural history of VUR is to resolution with time and/or that other factors are more important determinants of outcome. A more conservative approach to the management of UTI is warranted for most children. Antibiotic prophylaxis, voiding cystourethrography, and surgery for VUR are not indicated following an initial or infrequent UTI. These measures may have a role in selected subgroups of children at high risk of kidney disease, but this remains a hypothesis pending the results of ongoing trials.