title: Update on recent guidelines for the management of urinary tract infections in children:  the shifting paradigm.
abstract: OBJECTIVE
  Recent guidelines on the management of urinary tract infections (UTIs) in children have seen a shift from aggressive imaging studies and the use of prophylactic antibiotics to a more restrictive and targeted approach. This review focuses on new additions to the literature on management of UTI from January 2011 to September 2012.
  
  
  RESULTS
  The causal relationship between UTI-vesicoureteral reflux (VUR) and renal scarring has been challenged by several studies. Concerns about unnecessary exposure to ionizing radiation, invasiveness of some of the procedures, and risk of infection have also been raised. With improved prenatal ultrasound, a 'top-down' approach to investigating febrile UTI in children using renal bladder ultrasound alone as an initial study has become popular. Several studies have reported that prophylactic antibiotics and imaging studies after first UTI can be reduced substantially without affecting the risk of recurrent UTI or renal scarring.
  
  
  CONCLUSIONS
  The use of targeted imaging approach in evaluating febrile UTI in children may lead to improved resource use and reduction of potential harmful procedures and interventions, without affecting outcomes of UTI in children. Providers using current guidelines should endeavor to collect practice-based evidence to validate and inform future guidelines.
authors.affiliation: Departments of Pediatrics and Pharmacology, Yale School of Medicine, New Haven, Connecticut 06520-8064, USA. Elijah.paintsil@yale.edu
authors.forename: Elijah
authors.initials: E
authors.lastname: Paintsil
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000379:methods; D002648:Child; D002921:Cicatrix / Q000209:etiology; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D017410:Practice Guidelines as Topic; D014552:Urinary Tract Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D014718:Vesico-Ureteral Reflux / Q000150:complications
chemical_list: D000900:Anti-Bacterial Agents