Revised statement on management of urinary tract infections.

JUSTIFICATION: In 2001, the Indian Pediatric Nephrology Group formulated guidelines for management of patients with urinary tract infection (UTI). In view of emerging scientific literature, the recommendations have been reviewed. PROCESS: Following a preliminary meeting in November 2010, a document was circulated among the participants to arrive at a consensus on the evaluation and management of these patients.
OBJECTIVES: To revise and formulate guidelines on management of UTI in children. RECOMMENDATIONS: The need for accurate diagnosis of UTI is emphasized due to important implications concerning evaluation and follow up. Details regarding clinical features and diagnosis, choices and duration of therapy and protocol for follow up are discussed. UTI is diagnosed on a positive culture in a symptomatic child, and not merely by the presence of leukocyturia. The need for parenteral therapy in UTI in young infants and those showing toxicity is emphasized. Patients with aysmptomatic bacteriuria do not require treatment. The importance of bowel bladder dysfunction in the causation of recurrent UTI is highlighted. Infants with the first UTI should be evaluated with micturating cystourethrography. Vesicoureteric reflux (VUR) is initially managed with antibiotic prophylaxis. The prophylaxis is continued till 1 year of age in patients with VUR grades I and II, and till 5 years in those with higher grades of reflux or until it resolves. Patients and their families are counselled about the need for early recognition and therapy of UTI. Children with VUR should be followed up with serial ultrasonography and direct radionuclide cystograms every 2 years, while awaiting resolution. Siblings of patients with VUR should be screened by ultrasonography. Children with renal scars need long term follow up on yearly basis for growth, hypertension, proteinuria, and renal size and function.