Urinary tract infections in children and adolescents.

Recent advances in the understanding of urinary tract anatomy, function, and disease should lead to a reassessment of the clinical approach to urinary tract infection. Many traditional concepts must be seriously questioned in light of new information. These include the belief that pyuria or "typical" signs and symtoms are diagnostic. Diagnosis depends on detection of persistent bacteriuria by careful screening and culture of properly collected uring specimens. Once diagnosis is confirmed, oral administration of a single antibiotic for ten days is usually effective. Patients with suspected pyelonephritis or with recurrent or unresponsive urinary tract infection should be treated with two antibiotics. Success of treatment must always be confirmed by culture after discontinuance of therapy. In all cases, follow-up every one to two months should continue until the patients have remained free of infection for a period of one year. Refractory cases may require radiologic study and referral to a urologist.