Young children with initial urinary tract infections, new guidelines by american academy of pediatrics


Young children with initial urinary tract infections, new guidelines by american academy of pediatrics

A new approach for diagnosing and treating initial urinary tract infections (UTI) in infants and toddlers will affect thousands of children each year. The Indiana University School of Medicine, which conducted the research on request of the American Academy of Pediatrics (AAP), analyzed their findings based on a decade of scientific studies, and argues against the AAP's current guideline for the diagnosis and management tools for UTI infections in children, established in 1999.

Researchers of the IU School of Medicine urged for a change in the AAP's current guideline that exposes all small children diagnosed with initial UTIs to a painful radiologic test and against prescribing prophylactic antibiotic treatment that may carry on for years. As a result, the AAP has reviewed and changed its practice guideline on the diagnosis and management of initial UTIs in children aged 2 to 24 months. The report and the new AAP guideline is published in the September issue of the journal Pediatrics.

Five percent of babies and toddlers who develop a fever with no other obvious fever cause, suffer from UTIs, one of the most common bacterial infections in this age group. Diagnosis and treatment are clinically challenging, as patients as young as this are unable to communicate their symptoms, and the risk exists that repeated UTIs can lead to kidney scarring and life-long decreased kidney function.

To identify children with urine refluxing back up to the kidney, the AAP's 1999 guideline recommended a radiologic test called voiding cystourethrogram (VCUG) for young children after a first UTI. When positive, the treatment of prophylactic antibiotics was administered in an attempt to prevent repeated episodes of UTI. The researchers reviewed the studies that were conducted over the 10 years following the old 1999 guidelines, and discovered no benefit to long-term prophylactic antibiotics. Based on the fact that antibiotics are ineffective, they established that no grounds exist to expose all these children to pain and VCUG radiation.

S. Maria Finnell, M.D., assistant professor of pediatrics at the IU School of Medicine, lead author of the technical report and author of the AAP policy statement commented:

"If there is no obvious source of fever, the pediatrician needs to think UTI and needs to test for it. But we need to now change what we do after we have treated that first episode of UTI. We, as physicians, have been fooling ourselves by putting young patients on long-term antibiotics and thinking that would prevent the patient from getting another UTI."

"Technical Report-Diagnosis and Management of an Initial UTI in Febrile Infants and Young Children" accompanies the AAP's new clinical practice guidelines "Clinical Practice Guideline-Diagnosis and Management of Initial UTIs in Febrile Infants and Children Aged 2 to 24 Months." Stephen M. Downs, M.D., professor of pediatrics at the IU School of Medicine and co-author of the new technical report, who is also author of a 1999 technical report contributing to the earlier AAP guideline, added:

"The AAP is the authoritative source of pediatric guidelines in the United States and beyond. This change in recommendations will have a substantial impact on clinical practice."

American Academy of Pediatrics Five-Year Strategic​​​​​ Plan​ (Video Medical And Professional 2020).

Section Issues On Medicine: Medical practice