Urinary tract infections—current management

Urinary tract infections (UTI) are common in infants and in children, and an important cause of renal damage especially when associated with an underlying structural or functional abnormality of kidney and urinary tract. They must be suspected, correctly diagnosed, and appropriately treated. In infants, clinical features are nonspecific and urine should be examined in the presence of unexplained fever. Urine specimen should be carefully obtained and meticulously examined to avoid misleading results. The findings of urine microscopy and culture (both pyuria and bacteriuria are present in UTI) should be evaluated along with clinical features. Imaging studies are considered in every child with UTI, an expert ultrasound evaluation being the initial study. Voiding cystourethrography and dimercaptosuccinic acid (DMSA) scanning are carried out as necessary. Vesicoureteric reflux (VUR) has been managed with chemoprophylaxis, but it may be prudent to defer this measure in VUR grades 1-3. Antireflux procedures are considered in grade 5 VUR. Voiding dysfunction should be investigated in children with recurrent UTI.