Urinary tract infections in children

1. On the basis of strong research evidence, clinicians treating young children with fever without an apparent source should include UTI as part of the differential diagnosis. Clinicians should evaluate risk factors for UTI, including age, race, temperature, fever duration, and, in male patients, circumcision status. 2. On the basis of strong research evidence, young children with symptoms who are not low risk for UTI should undergo urinalysis. The urine specimen for urinalysis can be obtained via either bag or catheterization. Urine specimens obtained from bags can be helpful to rule out UTI if the results of the urinalysis are normal. However, if the urinalysis from the bag specimen has evidence of inflammation, catheterization is necessary for culture and repeat urinalysis. A culture should not be performed on a bag specimen. 3. On the basis of some research evidence, as well as consensus, the diagnosis of a UTI should include clinical symptoms, urinalysis with evidence of inflammation (leukocyte esterase and/or at least 5 WBCs per high-power field), and culture results of at least 50,000 CFU/mL of a typical uropathogen. 4. On the basis of strong research evidence, the choice of antibiotic therapy should take into account local susceptibility data, cost of the antibiotic, and patient compliance issues. Typical good choices, depending on local susceptibility, include cephalexin and trimethoprim-sulfamethoxazole. Trimethoprimsulfamethoxazole should not be used in infants less than 2 months of age. 5. On the basis of some research evidence, as well as consensus, young children with a febrile UTI should undergo renal and bladder ultrasonography to rule out anatomic abnormalities or signs of obstruction. VCUG should not be performed routinely after the first febrile UTI. 6. On the basis of some research evidence, as well as consensus, clinicians should screen for and manage bowel and bladder dysfunction in older children. Appropriately managing bowel and bladder dysfunction reduces the development of UTIs.