UTIs in Febrile Young Children

Voiding cystourethrography (VCUG) should not routinely be performed after a first UTI. It is recommended after an abnormal RBUS to identify high-grade vesicoureteral reflux or obstructive uropathy. VCUG should routinely be performed after a second febrile UTI.

Bottom Line

UTI should be considered in febrile infants aged 2-24 months without an obvious source of infection. Proper urine specimen collection should be completed before initiation of treatment. The presence of a positive urinalysis with more than 50,000 CFUs/mL of a uropathogen is required for a diagnosis of UTI. RBUS is used for initial evaluation. If abnormal, a VCUG is indicated. If normal, VCUG is only indicated for a second febrile UTI. Antimicrobial therapy should be initially based on local resistance patterns, and treatment should continue for 7-14 days.

Reference

• Urinary Tract Infection: Clinical Practice Guideline for the Diagnosis and Management of the Initial UTI in Febrile Infants and Children 2 to 24 Months (Pediatrics 2011;128:595-610).

Dr. Garman is a third-year resident in the family medicine residency program at Abington (Pa.) Memorial Hospital. Dr. Skolnik is an associate director of the family medicine residency program at Abington Memorial Hospital.