Children's UTIs in the new millennium - Diagnosis, investigation, and treatment of childhood urinary tract infections in the year 2001

OBJECTIVE To provide an effective approach for family physicians treating c hildren presenting with urinary tract infections (UTIs). QUALITY OF EVIDENCE The information presented, and articles quoted, are dra wn from both review of the literature and recent consensus guidelines. Data and recommendations come from prospective multicentre trials; retrospectiv e reviews; expert consensus statements; and some smaller trials, commentari es, and editorials. MAIN MESSAGE Urinary tract infections are often seen in family practice. Di agnosis requires suspicion and a realization that children, especially thos e younger than 2 years, often have very few, nonspecific signs of infection . Obtaining a proper urine sample is vital, because true infections require radiographic studies. Antibiotic prophylaxis is promoted because of the li nk between vesicoureteral reflux, recurrent UTIs, and renal scarring and hy pertension. We generally provide prophylaxis until children are 3 or 4 year s, when risk of damage from reflux is lessened and timely urine samples are easier to obtain for prompt therapy. Surgical opinion is sought only when medical management has failed. Failure is defined as either recurrent infec tions and pyelonephritis or poor renal growth. CONCLUSION To diagnose UTIs in children, physicians must suspect them, obta in proper urine samples, order appropriate investigations to rule out under lying anatomic abnormalities, and treat with appropriate antibiotics consid ering both organism sensitivities and length of therapy.