New evidence supports a more tailored approach to treating UTIs in children - Children's National

Urinary tract infections (UTIs) are among the most common bacterial infections in children, yet questions remain about how long treatment should last and how to prevent infections from coming back. To help answer them, Leena AlShenaiber, MPH, MD, a pediatric resident at Children's National, led a multidisciplinary team review of the latest evidence.

They analyzed studies published from 2008 through August 2023, focusing on the length and delivery of antibiotic treatment, the role of daily preventive antibiotics and how quickly children with a suspected UTI should be evaluated. The findings helped shape updated guidance from the American Academy of Pediatrics (AAP) for treating UTIs in children ages 8 days to 5 years.

Why it matters

For many children, longer treatment is not necessarily better. Those who are improving and do not have complicating medical conditions or urinary tract abnormalities may be treated effectively with a shorter course of antibiotics, reducing side effects and making it easier for families to complete treatment.

"A shorter course can make treatment easier on children and families without compromising care," said Dr. AlShenaiber. "The new guidance gives clinicians greater confidence to avoid unnecessary treatment and testing while still giving each child what they need to recover."

The review also found that oral antibiotics may be as effective as IV versions with the added benefit of avoiding IV complications and prolonged hospitalization. Intravenous treatment may still be needed if a child is seriously ill, cannot keep medicine down or has other complications, but it is not automatically the better option.

Preventive antibiotics should also be used selectively. They may help some children with recurring UTIs, including those with vesicoureteral reflux or bladder and bowel dysfunction, but clinicians and families should balance the potential benefit against side effects, treatment burden and antibiotic resistance.

The patient benefit

Preventing another UTI can involve more than medication. Constipation and bladder-bowel dysfunction can make infections more likely to return, so recognizing and treating these issues is an important part of a child's care.

When a UTI is suspected, prompt urine testing can confirm the infection, help clinicians choose the right treatment and spare children from antibiotics they do not need.

Bottom line

The updated guidance points toward care that is more precise and less burdensome. It recommends using the shortest effective antibiotic course, choosing oral medication when appropriate, reserving preventive antibiotics for children most likely to benefit and addressing bladder or bowel problems that can fuel repeat infections. Although some questions remain, the findings give clinicians a stronger foundation for tailoring treatment to each child.

Read the full report, A Systematic Review and Meta-Analysis of the Prevention and Management of Pediatric Urinary Tract Infection and Suspected Urinary Tract Infection: Technical Report, in Pediatrics.