Excerpt

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 health care. This change has contributed to uncertainty about the most appropriate and effective way to diagnose and treat UTI in children and whether or not investigations and follow-up are justified.

UTI is a common bacterial infection causing illness in children. It may be difficult to recognise UTI in children because the presenting symptoms and/or signs are non-specific, particularly in younger children. Urine collection and interpretation of urine tests in children are not easy and therefore it may not always be possible to unequivocally confirm the diagnosis.

Current management involving imaging, prophylaxis and prolonged follow-up has placed a heavy burden on NHS primary and secondary care resources. It is unpleasant for children and families, costly and based on limited evidence. The aim of this guideline is to lead to more consistent clinical practice by considering the importance of accurate diagnosis and the effectiveness of subsequent investigations and treatment (including surgical intervention) and follow-up in altering the outcome.

Contents

• Guideline Development Group membership and acknowledgements
• Abbreviations
• Glossary of terms
• 1. Scope and methodology
  • 1.1. Urinary tract infection
  • 1.2. Guideline objectives
  • 1.3. Areas outside of the remit of the guideline
  • 1.4. For whom is the guideline intended?
  • 1.5. Who has developed the guideline?
  • 1.6. Other relevant documents
  • 1.7. Guideline development methodology
  • 1.8. Schedule for updating the guideline
• 2. Summary of recommendations, patient flow pathway and algorithm
  • 2.1. Key priorities for implementation (key recommendations)
  • 2.2. Summary of recommendations
  • 2.3. Research recommendations
  • 2.4. Patient flow pathway
  • 2.5. Algorithm
• 3. Background
  • 3.1. Introduction
  • 3.2. Defining UTI
  • 3.3. Epidemiology
• 4. Diagnosis
  • 4.1. Introduction
  • 4.2. Predisposing factors
  • 4.3. Symptoms and signs
  • 4.4. Urine collection
  • 4.5. Urine preservation
  • 4.6. Urine testing
  • 4.7. Localisation of UTI
  • 4.8. GDG translation and recommendations
• 5. Acute management
  • 5.1. Antibiotic treatment for symptomatic UTI
  • 5.2. Symptomatic treatment
  • 5.3. GDG translation on antibiotic treatment during acute phase and recommendations
• 6. Long-term management
  • 6.1. Long-term impact of UTI
  • 6.2. Prevention of recurrence
  • 6.3. Antibiotic prophylaxis
  • 6.4. Imaging tests
  • 6.5. Surgical intervention for VUR
  • 6.6. Follow-up
• 7. Information and advice to children, young people and parents/carers
  • Introduction
  • Clinical question
  • Review findings – parents’ and carers’ understanding and experiences
  • GDG translation
• 8. Economic evaluation of management of UTI
  • Diagnosis and treatment of UTI in the short and long term
• Appendix A. Declarations of interest
• Appendix B. Clinical questions
• Appendix C. Estimated risk of ERF for children who have had UTI
• References
• Evidence tables
• Search strategies
• Excluded studies

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.