Management of Pediatric Urinary Tract Infections: A Delphi Study

Abstract

Urinary tract infection (UTI) is one of the most common infectious diseases in the pediatric population and represents a major cause of antibiotic consumption and hospitalization in children. Considering the ongoing controversies on the management of pediatric UTI and the challenges due to increasing antimicrobial resistance, the aim of the present study was to evaluate the level of agreement on UTI management in pediatric age in Emilia-Romagna Region, Italy, and to assess on the basis of recent studies whether there is the need to change current recommendations used by primary care pediatricians, hospital pediatricians, and pediatric surgeons in everyday clinical practice to possibly improve outcomes. This consensus provides clear and shared indications on UTI management in pediatric age, based on the most updated literature. This work represents, in our opinion, the most complete and up-to-date collection of statements on procedures to follow for pediatric UTI, in order to guide physicians in the management of the patient, standardize approaches, and avoid abuse and misuse of antibiotics. Undoubtedly, more randomized and controlled trials are needed in the pediatric population to better define the best therapeutic management in cases with antimicrobial resistance and real usefulness of long-term antibiotic prophylaxis.

Effective antimicrobial therapies of urinary tract infections among children in low‐ and middle‐income countries: A systematic review

“…However, integrated management guidelines are lacking in countries with poor socioeconomic status 26 . Already, several RCTs on different antimicrobial therapies to treat pediatric UTIs have been performed in high‐income countries to compare various aspects, such as efficacy, safety, tolerability, appropriate duration, and routes of administration, adverse events, and others but there is a significant deficiency of this information in LMICs 27 . Systematic reviews that were previously performed discussed the effective use and duration of multiple antibiotics used in pediatric UTIs.…”

“… 26 Already, several RCTs on different antimicrobial therapies to treat pediatric UTIs have been performed in high‐income countries to compare various aspects, such as efficacy, safety, tolerability, appropriate duration, and routes of administration, adverse events, and others but there is a significant deficiency of this information in LMICs. 27 Systematic reviews that were previously performed discussed the effective use and duration of multiple antibiotics used in pediatric UTIs. In the case of acute pyelonephritis in children, 14 days of oral treatment with third‐generation cephalosporin was found functional as a short‐course intravenous antibiotic treatment.…”

Profile and antibiotic susceptibility of urinary pathogenic bacteria in children attending Raparen Hospital, Erbil, Iraq

“…Considering the increasing resistance, the dependence on the cephalosporins family will increase the need for new alternative antibiotics (Hanna-Wakim et al, 2015). The prevalence of pathogens resistant to antibiotic therapy varies widely in different geographical areas (Autore et al, 2022).…”

“…Following the potty training in the early 6 months of a lifetime, the possibility of UTI is more for men, especially for uncircumcised males. The men to women rates are altered following the first 12 months of a lifetime, with more risk for females that continues into adulthood (Autore et al, 2022). Diagnosis in a newborn could be difficult, yet, in older children often present symptoms that mainly go along with urinary tract infection; for example urgency, frequency, dysuria also could show suprapubic tenderness during examination, from childhood UTI is a supreme factor influencing grown-up health.…”

Value of contrast-enhanced sonography in the diagnosis of vesicoureteral reflux

“…Continuous antibiotic prophylaxis is recommended by current guidelines in the case of diagnosed vesicoureteral reflux. However, this is being reexamined in new studies from the year 2023 4 41 . In the case of additional obstructive diseases of the urinary tract, antibiotic prophylaxis should be implemented 38 .…”