Evidence based management of childhood urinary tract infections

Urinary tract infection (UTI) is one of the common childhood bacterial infections. It affects 3.6% of boys and 11.3% of girls. Majority of them recover completely without long term sequelae. In the past it was thought that a significant proportion of children with UTI have structural abnormalities of the urinary tract which predispose them to recurrent infections. In addition, pyelonephritis and reflux nephropathy were believed to be major causes of chronic renal failure in children with high risk of hypertension and pregnancy associated complications in adulthood. Therefore, every young child after his or her first attack of UTI was exposed to a battery of predetermined radiological investigations to identify abnormalities. In the event of an anomalous imaging test this was followed by long term pharmacological therapy or corrective surgery to prevent further infection. Majority of these children with even minor structural abnormalities underwent the same imaging test more than once routinely, without much consideration to the invasive nature of these tests. Unfortunately, a significant proportion of them carried doubtful diagnoses of the first attack as well as recurrent attacks of UTI. Most of these older recommendations, in general, were based on expert opinion rather than solid scientific evidence derived from past studies which comprised highly selected populations with severe complicated disease 1 .