In the past 30–50 years, the natural history of urinary tract infection (UTI) in children has changed as a result of the introduction of antibiotics and improvements in healthcare. This change has contributed to uncertainty about the most appropriate and effective way to manage UTI in children, and whether or not investigations and follow-up are justified.
UTI is a common bacterial infection causing illness in infants and children. It may be difficult to recognise UTI in children because the presenting symptoms and signs are non-specific, particularly in infants and children younger than 3 years. Collecting urine and interpreting results are not easy in this age group, so it may not always be possible to unequivocally confirm the diagnosis.
Current management, which includes imaging, prophylaxis and prolonged follow‑up, has placed a heavy burden on NHS primary and secondary care resources. It is costly, based on limited evidence and is unpleasant for children and distressing for their parents or carers. The guideline has been developed with the aim of providing guidance on several aspects of UTI in infants and children from birth up to the age of 16 years, including: when to consider the diagnosis of UTI in sick and/or symptomatic infants and children who were previously healthy; urine collection for the diagnosis of UTI in infants and children; tests to establish or exclude UTI; treatment, including symptomatic reinfection; use of prophylactic antibiotics and investigations to assess the structure and function of the urinary tract; referral to secondary and tertiary care; surgical intervention; long-term follow-up; and advice to give to parents or carers, including what to do if another UTI occurs.
Areas not addressed by the guideline include children with urinary catheters in situ, children with neurogenic bladders, children already known to have significant pre-existing uropathies, children with underlying renal disease (for example, nephrotic syndrome), immunosupressed children, and infants and children in intensive care units. It also does not cover preventive measures or long-term management of sexually active girls with recurrent UTI.
In 2017, we updated the recommendations on urine testing strategies for infants and children under 3 years.