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Urinary tract infections in children: Long-term management and prevention

INTRODUCTION

Urinary tract infection (UTI) is a frequently occurring clinical problem in childhood. Upper urinary tract infections (ie, acute pyelonephritis) may lead to renal scarring, hypertension, and end-stage renal dysfunction. Although children with pyelonephritis tend to present with fever, it is often difficult on clinical grounds to distinguish cystitis from pyelonephritis, particularly in young children (aged <2 years) [1]. Thus, we have defined UTI broadly here without attempting to distinguish cystitis from pyelonephritis. Acute cystitis in older children is discussed separately. (See "Acute cystitis: Clinical features and diagnosis in children older than two years and adolescents".)

The long-term management and prevention of UTI in children will be reviewed here. The epidemiology, risk factors, clinical features, diagnosis, acute management, and prognosis of UTI in children and UTI in newborns are discussed separately. (See "Urinary tract infections in children: Epidemiology and risk factors" and "Urinary tract infections in infants and children older than one month: Clinical features and diagnosis" and "Urinary tract infections in infants and children older than one month: Acute management, imaging, and prognosis" and "Urinary tract infections in newborns".)

LONG-TERM MANAGEMENT

Recurrent symptoms — Approximately 8 to 30 percent of children with urinary tract infection (UTI) experience one or more symptomatic reinfections [2-5]. Breakthrough UTI are most common in girls [6].

Progression of renal scarring is associated with recurrent episodes of pyelonephritis [7-10]. Accordingly, prompt diagnosis and treatment of these infections is critically important in reducing renal scarring [2,11,12].

Families of young children with UTI should receive instruction about the risk of recurrent UTI and be advised to seek medical attention promptly for fever and/or urinary symptoms. The evaluation of these episodes should include urinalysis, urine culture, or both [1,13]. (See "Urinary tract infections in infants and children older than one month: Clinical features and diagnosis", section on 'Laboratory evaluation'.)

        

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Literature review current through: Jul 2014. | This topic last updated: Mar 18, 2014.
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