Urinary tract infection in children.

Up to 7 percent of girls and 2 percent of boys will have a symptomatic, culture-confirmed urinary tract infection by six years of age. Urinary tract infection may be suspected because of urinary symptoms in older children or because of fever, nonspecific symptoms, or failure to thrive in infants. Urine dipstick analysis is useful for ruling out urinary tract infections in cases with low clinical suspicion. However, urine culture is necessary for diagnosis of urinary tract infections in children if there is high clinical suspicion, cloudy urine, or if urine dipstick testing shows positive leukocyte esterase or nitrite activity. Despite current recommendations, routine imaging studies (e.g., renal ultrasonography, voiding cystourethrography, renal scans) do not appear to improve clinical outcomes in uncomplicated urinary tract infections. Oral antibiotics are as effective as parenteral therapy in randomized trials. The optimal duration of antibiotic therapy has not been established, but one-day therapies have been shown to be inferior to longer treatment courses.