Urinary tract infections in children: Long-term management and prevention
- Nader Shaikh, MD
Nader Shaikh, MD
- Assistant Professor of Pediatrics
- University of Pittsburgh School of Medicine
- Alejandro Hoberman, MD
Alejandro Hoberman, MD
- Associate Professor of Pediatrics
- University of Pittsburgh School of Medicine
- Section Editors
- Tej K Mattoo, MD, DCH, FRCP
Tej K Mattoo, MD, DCH, FRCP
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Wayne State University School of Medicine
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Urinary tract infection (UTI) is a frequently occurring clinical problem in childhood. Upper UTIs (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) . 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 older than one month and young children: Acute management, imaging, and prognosis" and "Urinary tract infections in neonates".)
Children without vesicoureteral reflux
Progression of renal scarring is associated with recurrent episodes of pyelonephritis [8-11]. Accordingly, prompt diagnosis and treatment of these infections is critically important in reducing renal scarring [2,12-15].
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 [1,16,17]; a delay in the treatment of febrile UTIs is associated with increased risk for renal scarring . (See "Urinary tract infections in infants and children older than one month: Clinical features and diagnosis", section on 'Laboratory evaluation'.)
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- LONG-TERM MANAGEMENT
- Children without vesicoureteral reflux
- - Monitor for recurrent symptoms
- - Identify and treat bowel and bladder dysfunction
- Children with vesicoureteral reflux
- PREVENTION OF RECURRENT UTI IN CHILDREN WITHOUT VESICOURETERAL REFLUX
- Antimicrobial prophylaxis
- Unproven interventions
- - Surveillance cultures
- - Cranberry juice
- - Probiotics
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS