Urinary tract infection in children

Nicholas G. Larkins, Ian K. Hewitt

Research output: Contribution to journalReview article

Abstract

Purpose of Review

Urinary tract infections (UTI) are common among children. In the past 20 years, a number of key trials have substantially changed practice, in addition to clarifying the natural history of children managed expectantly. It is now clear that among children with normal kidneys at presentation, chronic kidney disease and hypertension are rare. Improved antenatal ultrasound now detects most significant abnormalities of the kidney and urinary tract, particularly severe hypodysplasia, which is often associated with high-grade vesico-ureteric reflux (VUR). This review aims to summarize the evidence-based treatment of UTI in children.

Recent Findings

There is no difference in symptomatic, microbiologic, or renal outcomes between intravenous and oral antibiotics in treating acute, febrile infection. Long-term antibiotic prophylaxis results in a statistically but not clinically significant reduction in recurrence among young children, with or without VUR. Trials to-date have failed to demonstrate that the surgical correction of VUR confers any additional benefit, which may be because the natural history of VUR is to resolution with time and/or that other factors are more important determinants of outcome.

Summary

A more conservative approach to the management of UTI is warranted for most children. Antibiotic prophylaxis, voiding cystourethrography, and surgery for VUR are not indicated following an initial or infrequent UTI. These measures may have a role in selected subgroups of children at high risk of kidney disease, but this remains a hypothesis pending the results of ongoing trials.
Original languageEnglish
Pages (from-to)259-268
Number of pages10
Journal Current Pediatrics Reports
Volume6
Issue number4
Early online date10 Nov 2018
DOIs
Publication statusPublished - Dec 2018

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Urinary Tract Infections
Antibiotic Prophylaxis
Natural History
Kidney
Kidney Diseases
Infection
Urinary Tract
Chronic Renal Insufficiency
Fever
Anti-Bacterial Agents
Hypertension
Recurrence

Cite this

Larkins, Nicholas G. ; Hewitt, Ian K. / Urinary tract infection in children. In: Current Pediatrics Reports. 2018 ; Vol. 6, No. 4. pp. 259-268.
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abstract = "Purpose of ReviewUrinary tract infections (UTI) are common among children. In the past 20 years, a number of key trials have substantially changed practice, in addition to clarifying the natural history of children managed expectantly. It is now clear that among children with normal kidneys at presentation, chronic kidney disease and hypertension are rare. Improved antenatal ultrasound now detects most significant abnormalities of the kidney and urinary tract, particularly severe hypodysplasia, which is often associated with high-grade vesico-ureteric reflux (VUR). This review aims to summarize the evidence-based treatment of UTI in children.Recent FindingsThere is no difference in symptomatic, microbiologic, or renal outcomes between intravenous and oral antibiotics in treating acute, febrile infection. Long-term antibiotic prophylaxis results in a statistically but not clinically significant reduction in recurrence among young children, with or without VUR. Trials to-date have failed to demonstrate that the surgical correction of VUR confers any additional benefit, which may be because the natural history of VUR is to resolution with time and/or that other factors are more important determinants of outcome.SummaryA more conservative approach to the management of UTI is warranted for most children. Antibiotic prophylaxis, voiding cystourethrography, and surgery for VUR are not indicated following an initial or infrequent UTI. These measures may have a role in selected subgroups of children at high risk of kidney disease, but this remains a hypothesis pending the results of ongoing trials.",
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Urinary tract infection in children. / Larkins, Nicholas G.; Hewitt, Ian K.

In: Current Pediatrics Reports, Vol. 6, No. 4, 12.2018, p. 259-268.

Research output: Contribution to journalReview article

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AB - Purpose of ReviewUrinary tract infections (UTI) are common among children. In the past 20 years, a number of key trials have substantially changed practice, in addition to clarifying the natural history of children managed expectantly. It is now clear that among children with normal kidneys at presentation, chronic kidney disease and hypertension are rare. Improved antenatal ultrasound now detects most significant abnormalities of the kidney and urinary tract, particularly severe hypodysplasia, which is often associated with high-grade vesico-ureteric reflux (VUR). This review aims to summarize the evidence-based treatment of UTI in children.Recent FindingsThere is no difference in symptomatic, microbiologic, or renal outcomes between intravenous and oral antibiotics in treating acute, febrile infection. Long-term antibiotic prophylaxis results in a statistically but not clinically significant reduction in recurrence among young children, with or without VUR. Trials to-date have failed to demonstrate that the surgical correction of VUR confers any additional benefit, which may be because the natural history of VUR is to resolution with time and/or that other factors are more important determinants of outcome.SummaryA more conservative approach to the management of UTI is warranted for most children. Antibiotic prophylaxis, voiding cystourethrography, and surgery for VUR are not indicated following an initial or infrequent UTI. These measures may have a role in selected subgroups of children at high risk of kidney disease, but this remains a hypothesis pending the results of ongoing trials.

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