Children's UTIs in the new millennium. Diagnosis, investigation, and treatment of childhood urinary tract infections in the year 2001.
OBJECTIVE
To provide an effective approach for family physicians treating children presenting with urinary tract infections (UTIs).


METHODS
The information presented, and articles quoted, are drawn from both review of the literature and recent consensus guidelines. Data and recommendations come from prospective multicentre trials; retrospective reviews; expert consensus statements; and some smaller trials, commentaries, and editorials.


RESULTS
Urinary tract infections are often seen in family practice. Diagnosis requires suspicion and a realization that children, especially those younger than 2 years, often have very few, nonspecific signs of infection. Obtaining a proper urine sample is vital, because true infections require radiographic studies. Antibiotic prophylaxis is promoted because of the link between vesicoureteral reflux, recurrent UTIs, and renal scarring and hypertension. We generally provide prophylaxis until children are 3 or 4 years, when risk of damage from reflux is lessened and timely urine samples are easier to obtain for prompt therapy. Surgical opinion is sought only when medical management has failed. Failure is defined as either recurrent infections and pyelonephritis or poor renal growth.


CONCLUSIONS
To diagnose UTIs in children, physicians must suspect them, obtain proper urine samples, order appropriate investigations to rule out underlying anatomic abnormalities, and treat with appropriate antibiotics considering both organism sensitivities and length of therapy.
White
C T
CT
Section of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Western Ontario, University of Western Ontario, London.
Matsell
D G
DG
D000367:Age Factors; D000465:Algorithms; D019072:Antibiotic Prophylaxis; D002648:Child; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D014718:Vesico-Ureteral Reflux / Q000382:microbiology / Q000517:prevention & control