Management of children with unobstructed urinary tract infection

Abstract

There are two major considerations when taking care of children with urinary tract infection (UTI): firstly to prevent renal damage and secondly to relieve symptoms. A distinction should always be made between these two aims, since they often concern separate populations that may need different treatment and follow-up strategies. Acute pyelonephritis is a common disorder of infancy and early childhood which is easily overlooked. In all infants and children in whom the cause of fever is not apparent and in all those failing to thrive, urine should be examined by dip slide culture and by an estimation of leucocyte content. With adequate care the immediate and long-term prognosis of acute pyelonephritis is excellent. Thus prevention of kidney damage is mainly a matter of putting existing knowledge into practice. Uncomplicated recurrent lower UTI involves a low risk of renal damage. Short courses of antibiotic treatment easily eradicate most such infections but have no effect on the mechanisms underlying the susceptibility to recurrence. Single-dose therapy should be considered in such instances. Long-term antibiotic prophylaxis is mainly indicated in children with a high risk of renal scarring. Treatment is not recommended for children with asymptomatic bacteriuria.