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Radiologic investigation recommended only for at-risk children with UTI
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Current urinary tract infection guidelines recommend radiological investigations only in at-risk children and discourage routine prophylactic antibiotic use, according to a recent report published in the Journal of Tropical Pediatrics.
“Imaging tests have been traditionally performed in pediatric patients with UTI with the aim of detecting renal anomalies and vesicoureteral reflux,” researchers wrote. “It was thought that the detection of [vesicoureteral reflux] would give an opportunity for physicians to intervene early, either by treating the [vesicoureteral reflux] surgically or by using prophylactic antibiotics to prevent subsequent renal scarring.”
New UTI guideline recommendations from AAP and the National Institute for Health and Clinical Excelled in the UK state that radiologic investigations should be reduced. Previous studies have shown that malformations were only found in a small percentage of children with their first UTI and a history of a normal urinary tract ultrasound antenatally. Most significant renal anomalies were found antenatally during routine ultrasound in mothers.
The recommendations include:
- UTI evaluation should focus on renal status instead of presence or absence of vesicoureteral reflux;
- Radiological investigations should focus on those children with recurrent UTIs or atypical presentation;
- Micturating cystourethrogram should only be used in patients with positive dimercaptosuccinic acid scans or recurrent febrile UTI; and
- Antibiotic prophylaxis should not be used routinely.
“More investigations might be justified in developing countries with a higher risk of diagnostic delay and fewer prenatal ultrasound scans,” researchers wrote.
Disclosure: The study was funded in part by the Deanship of Scientific Research and King Abdulaziz University, Jeddah. The authors report no relevant financial disclosures.
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