The management of urinary infections in children.

Urinary tract infection is a common disorder of childhood which frequently causes no symptoms. Bacteriological proof should always be obtained because symptoms may be misleading. The diagnosis of a first infection should lead to radiological investigation. Routine tests to localize the site of infection are not yet available but their use in the future in conjunction with increased awareness of the factors leading to pyelonephritis should help to identify children at risk from renal damage. Two thirds of children with urinary infections have normal lower urinary tracts or only minor abnormalities and may be treated for symptomatic infections with intermittent antibiotics. The risk of renal damage from infection is virtually confined to the remainder: children with obstructive uropathy, preschool children with severe vesicoureteric reflux, and those with pre-existing chronic renal failure. It remains to be shown by controlled therapeutic trials whether renal scarring can be prevented by long-term chemoprophylaxis or surgical correction of reflux. Until the results of current trails are known, children with reflux or impaired renal function should be treated medically in the first instance and screening of healthy children for covert bacteriuria should probably be confined to the preschool age-group.