Urinary tract infections: evaluation and treatment.

Urinary tract infections (UTI) are the second most common bacterial infection in children after those of the respiratory tract. These infections are important in view of their acute morbidity and the long-term risk of renal scarring. Occurrence of UTI below two years of age, delay in starting treatment and presence of vesicoureteric reflux or obstruction are the chief risk factors associated with renal scarring. The classical features of UTI are absent in young children, who often present with few signs or symptoms other than fever. Since the diagnosis of UTI warrants a thorough evaluation subsequently, empiric treatment based on symptoms or urinalysis alone should be avoided. Therapy with appropriate antibiotics is started only after obtaining a urine culture. The distinction between upper and lower urinary tract infections is difficult and the choice of therapy guided by the patient's age and severity of clinical manifestations. All children with UTI should be investigated to identify those with an underlying urinary tract anomaly.