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Management of urinary tract infections in children: simplifying the controversies?

The management of urinary tract infections (UTIs) in children has confused urologists for decades. The controversy regarding whom to investigate, how to investigate, and how to treat has embroiled pediatric urologists in what seems to be an endless debate. The general urologist, who also covers pediatric urology, is left out of the loop and has to make decisions about these questions on a daily basis. Guidelines from the American Academy of Pediatrics recommend obtaining a voiding cystourethrogram and a renal ultrasonogram for young children after the first UTI; however, many practicing urologists do not consistently perform these tests or use other methods to determine the integrity of the urinary tract. This is because many feel that the results of the tests do not influence the management plan they adopt. Similarly, once the UTI has occurred, the optimal duration of oral antibiotic therapy for UTI in children has never been determined to every urologist’s satisfaction.