Note: This guideline has been updated. The National Guideline Clearinghouse (NGC) is working to update this summary. The recommendations that follow are based on the previous version of the guideline.
The following is a summary of the recommendations for urinary tract infections in children. Refer to the original guideline for more detailed recommendations and discussion.
Levels of evidence (Ia-IV) and grades of recommendation (A-C) are defined at the end of the "Major Recommendations" field.
Urinary tract infection (UTI) in children is a frequent health problem, with the incidence of UTIs only a little lower than the incidences for upper respiratory and digestive infections.
The incidence of UTI varies depending on age and sex. In the first year of life, mostly the first 3 months, UTI is more common in boys (3.7%) than in girls (2%), after which the incidence changes, being 3% in girls and 1.1% in boys. Paediatric UTI is the most common cause of fever of unknown origin in boys less than 3 years. The clinical presentation of a UTI in infants and young children can vary from fever to gastrointestinal, lower or upper urinary tract symptoms.
Investigation should be undertaken after two episodes of a UTI in girls and one in boys (B). The objective is to rule out the unusual occurrence of obstruction, vesicoureteric reflux (VUR) and dysfunctional voiding (e.g., as caused by a neuropathic disorder).
Chronic pyelonephritic renal scarring develops very early in life due to the combination of a UTI, intrarenal reflux and VUR. It sometimes arises in utero due to dysplasia. Although rare, renal scarring may lead to severe long-term complications such as hypertension and chronic renal failure.
Vesicoureteric reflux is treated with long-term prophylactic antibiotics (B). Surgical re-implantation or endoscopic treatment is reserved for the small number of children with breakthrough infection (B).
In the treatment of a UTI in children, short courses are not advised and therefore treatment is continued for 5-7 days and longer (A). If the child is severely ill with vomiting and dehydration, hospital admission is required and parenteral antibiotics are given initially (A).
Definitions:
Levels of Evidence
Ia Evidence obtained from meta-analysis of randomized trials
Ib Evidence obtained from at least one randomized trial
IIa Evidence obtained from at least one well-designed controlled study without randomization
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study
III Evidence obtained from well-designed non-experimental studies, such as comparative studies, correlation studies and case reports
IV Evidence obtained from expert committee reports or opinions or clinical experience of respected authorities
Grades of Recommendation
- Based on clinical studies of good quality and consistency addressing the specific recommendations and including at least one randomized trial
- Based on well-conducted clinical studies, but without randomized clinical studies
- Made despite the absence of directly applicable clinical studies of good quality