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HM14 Report: Review of New Guidelines for Pediatric UTI

Presenter: Maria Finnell, MD

Summation: Dr. Finnell reviewed in detail the recommendations and controversies surrounding the revised 2011 guidelines. The thrust was on more refined diagnostic criteria and rigorous review of diagnostic options (ultrasound, VCUG) and therapeutic options (length of treatment, IV vs oral antibiotics, and prophylactic therapy).

Key Takeaways

  1. The diagnosis of a UTI is based on an abnormal urinalysis and a positive urine culture, now defined as >50,000 CFU/ml. A bag-colleted urine is not very effective in truly diagnosing a UTI (due to excessive false positives).
  2. Oral treatment is as effective as IV therapy.
  3. Duration of 7-14 days is recommended. There is not definitive evidence to support a more specific length at this time.
  4. A VCUG is not recommended after a 1st febrile UTI for children 2 months- 2 years of age.
  5. Antibiotic prophylaxis does increase antibiotic resistance and is not clearly helpful for reflux grades 1-2. For reflux grades 3-5, it may still be effective.
  6. Educating parents of children who have had a 1st febrile UTI to arrange for early evaluation of a possible secondary febrile UTIs is key in catching UTIs early.

Dr. Harlan is a pediatric hospitalist, medical director with IPC The Hospitalist Company, and member of Team Hospitalist.

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