Urinary tract infections in children: recommendations for antibiotic prophylaxis and evaluation. An evidence-based approach.
Urinary tract infections (UTIs) are common in children, but the routine work-up and treatment recommendations are still controversial. Long-term complications, including renal scarring, hypertension, and renal failure, have been the main concern and the reason for use of antibiotic prophylaxis and invasive imaging techniques. In the past several years, numerous studies have been published comparing different imaging protocols and questioning the use of antibiotic prophylaxis. The latest guidelines from the United Kingdom, published in 2007, recommend more selective approach based on evidence. In this review, we critically appraise the literature published in the past 5 years. The risk of developing long-term complications after a UTI is extremely low, and the evidence suggests selective imaging to a select group of children at risk. Finding those at risk for long-term complications is yet to be determined.
Merguerian
Paul A
PA
Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH, 03755, USA. Paul.A.Merguerian@Hitchcock.org
Sverrisson
Einar F
EF
Herz
Daniel B
DB
McQuiston
Leslie T
LT
D000892:Anti-Infective Agents, Urinary / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000009:adverse effects*; D002675:Child, Preschool; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000517:prevention & control; D014718:Vesico-Ureteral Reflux / Q000188:drug therapy* / Q000517:prevention & control
D000892:Anti-Infective Agents, Urinary