Thorough early diagnosis and treatment of children with Urinary tract infections
Tuesday, 4 March 2008 - Urinary tract infections (UTI) in children are subjects to an ongoing scientific debate. The British National Institute for Health and Clinical Excellence (NICE) has published guidelines on diagnosis and management. As Urology News underlines in a recent analysis, the new guideline recommends “early diagnosis and treatment of children with UTI” instead of extensive radiological investigations.
These extensive investigations should be limited to a selected group of children. According to the review, the NICE Guideline Development Group (GDG) recommends to reduce radiological investigations after a single uncomplicated UTI. There is only poor evidence for the extensive radiological investigations in these cases. Therefore these investigations should be limited to children with an increased risk of having a “significant urinary tract anomaly”.
As a substitute early diagnosis and treatment are considered to be crucial in preventing acquired renal scarring. This is true for small children with acute pyelonephritis or febrile UTI, as Urology News report.
Regarding empiric treatment in children with symptoms compatible with UTI, the treatment should be started before urine culture is back. It can be modified to the culture afterwards. If fever and kidney involvement are apparent, children should get much better from the treatment within two days.
There is only little support for the practice to widely use antibiotic prophylaxis in children with previous UTI and in those with vesicoureteric reflux (VUR). “We could, however, at present only conclude that prophylactic antibiotic treatment in these children should not be used routinely,” Urology News points out in their review.
Reference: Urology News, 12, No 2, 2008: 8-9