UTI Management Controversies
The management of UTI in children remains one of the most controversial issues in pediatrics. Lack of agreement often exists in both diagnosis and treatment, which, at first sight, seem simple and straightforward. The major contributing factor to the controversy is probably the difficulty to diagnose UTI in young, not toilet-trained children. Difficulties in defining which children to test, in obtaining an appropriate sample and in interpreting the results lead to substantial under- and over-diagnosis. Acutely unwell preschool children seek more healthcare consultations than any other group of patients, hence identifying which children should be investigated for a UTI is a challenge for clinicians. Therapeutic decisions are not less demanding. The most appropriate antibiotics and the route of administration must be decided before the result of the culture is known. Disease severity, the increasing resistance of uropathogens, known urological anomalies and use of prophylaxis or prior exposure to antibiotics should be taken into account.
Expert Rev Anti Infect Ther. 2012;10(10):1153-1164. © 2012 Expert Reviews Ltd.