Diagnostic and therapeutic management of the urinary tract infection in childhood

The updated recommendations for the therapeutic and diagnostic management of the urinary tract infection in childhood are presented. The most appropriate urine collection techniques are differentiated according to the capacity of the child to control the urination and the urgency of the diagnosis. Directives for the interpretation of the different parameters of the urinalysis are offered, recommending to sustain the diagnosis of urinary infection in the urine culture. The indication of hospitalization does not depend on the location of the urinary infection but on the degree of repercussion and the risk of complications of the patient. Guidelines of first election and alternative antibiotic treatment are established, for their parenteral or oral administration, as well as recommendations for the election of the route, the rhythm and the duration of the treatment, based on the risk level of the patient. The routine antibiotic prophylaxis in children with normal urinary tract, after a first episode of urinary infection, or in children with low grade vesico-ureteral reflux is not recommended; the indication of prophylaxis in patients with recurrent infections or with high degree reflux must be individualized. It is recommended to change the present strategy of routine use of diagnostic imaging test by another one in which they are only indicated in individualy, considering the level of risk of each patient.