Urinary Tract Infection in Childhood

Abstract

The physician interested in primary care must recognize his responsibility in correctly diagnosing and properly treating children with urinary tract infections (UTIs). Despite some recent reviews,1,3 physicians may be confused and unsure of themselves in this area. They have been told by pathologists that chronic pyelonephritis is not usually due to UTI,4 that screening for UTI in females is5 (is not6) valuable, that aggressive urologic evaluation is of questionable importance,7-9. that there is danger in overdiagnosis3 (underdiagnosis2), and that the prognosis of UTI is unknown.5 What can the clinician do to help (and not inadvertently harm) his patient in the face of such controversy? One possible approach is to present the areas of controversy and to allow each practitioner the opportunity to draw his own conclusions. The following review is intended as a discussion of the problems presented by children with UTI and a statement of one physician's principles of management. INCIDENCE The incidence of UTI varies with age. The only careful prospective studies that have been done have assessed the prevalence (number positive at one point in time) of asymptomatic bacteriuria (ABU). The frequency of symptomatic UTI is less than ABU at each age, but precise data are not available. Estimates are that as many as 50% of patients with ABU may have had previous symptomatic UTI.10 In premature newborns, the prevalence of ABU is approximately 3%11; in term infants, 1%11; in the age group 1 to 5 years, 1%12; and in the school-age child,1.5%.6.13-16 Except for the