What do you do when kids get a urinary tract infection (UTI)?
It would seem like the treatment is simple enough. Just give them antibiotics, right?
The treatment of UTIs is actually a fairly controversial thing in pediatrics. Not necessarily because of confusion about what to do when you diagnose a UTI, but knowing what to do afterwards.
Testing with a renal sonogram and a voiding cystourethogram (VCUG) was routine after diagnose of a UTI in most kids. This helped to detect those kids who had vesicoureteral reflux.
Some doctors have switched to doing an acute-phase Tc-99m dimercaptosuccinic acid (DMSA) renal-scan instead, since it less invasive than a VCUG. Some studies have shown that may not be a good idea though.
Why all of the fuss?
Febrile urinary tract infections can cause renal scarring, which can later lead to problems with high blood pressure and end-stage renal disease. So you don't want to miss any problems, but you also don't want to overdo invasive tests unless they are going to be helpful.
New clinical practice guidelines from the AAP, which will be printed in the September issue of Pediatrics, offers "7 key action statements for the diagnosis and treatment of infants and young children 2 to 24 months of age with UTI and unexplained fever."
The new recommendations include that, among other things:
- kids with fever and no source, who are not ill appearing, and who have a low likelihood of UTI can sometimes be followed without testing (they shouldn't be given antibiotics though)
- kids should have both a positive urinalysis and a positive urine culture before being diagnosed with a UTI and starting antibiotics - a positive culture by itself might only indicate asymptomatic bacteriuria
- antibiotics should be given for 7 to 14 days
- kids with a UTI and fever should have a renal and bladder ultrasound
- a VCUG should usually only be done if a problem is detected on the child's ultrasound or if the child has multiple febrile UTIs
Most importantly, once diagnosed with a febrile UTI, parents should know to seek quick medical attention whenever their child has a fever in the future, to make sure they don't have another UTI.
The new guidelines will be good news for parents who never seemed to like the idea of having a VCUG being done on their child.