The AAP practice parameter on urinary tract infections in febrile infants and young children. American Academy of Pediatrics.

Abstract

The Committee on Quality Improvement of the American Academy of Pediatrics developed an evidence-based practice parameter on the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children, two months to two years of age. The practice parameter consists of 11 recommendations and four areas for future research. Recommendations 1 through 5 address diagnosis and emphasize the need for culturing appropriately collected specimens; diagnosis should not be based on urinalysis or on culture of specimens from urine-collection bags. Recommendations 6 through 10 address treatment, identifying trimethoprim-sulfamethoxazole as superior to amoxicillin and establishing the duration of treatment as seven to 14 days. Children should receive antimicrobial coverage until imaging studies have been completed. Recommendation 11 addresses imaging; all infants should undergo ultrasonography, and a lower tract study is strongly encouraged as well. Future research should quantitatively address the relationship between renal scarring in childhood and renal impairment and hypertension in adults. Less invasive methods of diagnosis and imaging are highly desirable and should be developed.