The American Academy of Pediatrics had issued guidelines for the management of urinary tract infections (UTI) in febrile infants and young children, way back in 1999. An analysis of the medical literature on UTI in this age group, published since the last version of guidelines was issued, was recently done. Based on this analysis, the American Academy of Pediatrics has revised the old parameters and come up with a fresh set of guidelines for the diagnosis and management of UTI in small children.
The committee has recommended seven key points for the diagnosis and treatment of infants and young children 2 to 24 months of age with UTI and unexplained fever. They include:
• A diagnosis of UTI is made if 50,000 colonies of a single pathogen are present per mL in a properly collected sample of urine and there is evidence of pyuria.
• The sample of urine to be examined and cultured should be collected through a catheter or a supra-pubic aspiration. A sample collected from a bag may be contaminated and is not ideal for urine culture for diagnosing UTI.
• The choice of antibiotic to be started should depend upon antimicrobial sensitivity patterns. After 7 to 14 days of antibiotic therapy, follow up monitoring should be done to promptly identify and treat any recurrent infection.
• The anatomy of the kidneys and the bladder should be examined with the help of ultrasonography to detect any abnormalities.
• A VCUG is recommended only if there is any evidence of hydronephrosis, scarring, or other findings that would suggest either high-grade VUR or obstructive uropathy, and in other atypical or complex clinical circumstances.
• A recurrence of febrile UTI also merits a VCUG.
• In case of recurrence of any febrile illness in the child in the future, parents are recommended to seek medical attention promptly, preferably within 48 hours of the onset of the febrile illness. This will ensure a fast diagnosis and early treatment of any recurrent UTI.
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