Childhood urinary tract infections: an evidence-based approach

Urinary tract infections (UTIs) are a common childhood problem and a frequent reason for presentation in both primary care and hospital settings. Severity ranges from simple cystitis to pyelonephritis; symptoms may be typical of urinary tract infection or may be non-specific. Decision-making can be challenging in the acute setting and when planning follow-up. Clinicians need evidence to correctly answer questions such as: What method of sampling is most reliable? Can I rely on dipstick urinalysis to diagnose a UTI? Are infants particularly at risk of meningitis during UTI and should I obtain cerebro-spinal fluid and what imaging will aid my management of this child? Even experienced clinicians vary in their answers to these clinical questions. Through a case-based approach, this article aims to help clinicians make these decisions, highlighting well-established guidance, in addition to newly published evidence.