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New guidelines for managing urinary tract infection in febrile infants

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – New clinical guidelines from the American Academy of Pediatrics (AAP) recommend a less invasive approach to the diagnosis and management of urinary tract infection (UTI) in febrile infants and children 2 to 24 months old.

The biggest change, Dr. Kenneth B. Roberts, who chairs the AAP’s Subcommittee on Urinary Tract Infection, told Reuters Health is that “VCUGs (voiding cystourethrography) are no longer recommended to be performed routinely after the first febrile UTI in an infant between 2 and 24 months of age.”

“Renal-bladder ultrasonography (RBUS) should be performed but voiding cystourethrography (VCUG) is no longer recommended routinely after the first febrile UTI,” Dr. Roberts explained. “Indications for VCUG include a) findings on RBUS that suggest the presence of high grade vesico-ureteral reflux or b) the recurrence of a febrile UTI.”

Other key changes published in the August 29th online issue of Pediatrics include the requirement for both an abnormal urinalysis and a positive urine culture (at least 50,000 colony forming units of a single urinary pathogen) to make the diagnosis of UTI and the recognition of oral antimicrobial therapy as being as effective as parenteral therapy for initial treatment.

As for follow-up, Dr. Roberts said, “Emphasis should be on counseling families to promptly seek medical evaluation for UTI during future febrile illnesses.”

The report also includes 8 recommendations for further research, as well as a detailed algorithm for following the clinical practice guidelines in a given patient.

Supporting the new guidelines is a detailed technical report prepared by Dr. S. Maria E. Finnell and colleagues on the Subcommittee on Urinary Tract Infection.

According to this report, although the recent literature agrees with most of the evidence presented in the 1999 technical report that supported the 1999 clinical guidelines, meta-analyses of data from recent trials do not support antimicrobial prophylaxis to prevent febrile UTI.

Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months
Pediatrics 2011;128:595-610,e749-e770.