Asian guidelines for urinary tract infection in children

The followings are the level of evidence (LE) and grade recommendation (GR) on pediatric UTI in Asia. Classification according to sites infection (lower versus upper tract), number episode (first recurrent), severity (simple severe), or existence complicating factor (uncomplicated complicated) is useful differentiate children with whether they at risk renal damage not (LE: 2, GR: B). Diagnosis requires both urinalysis that suggests positive urine culture (LE:3, GR For pre-toilet trained children, specimen for should be collected by urethral catheterization suprapubic aspiration. toilet midstream clean catch reliable 3, A). Urine considered if it demonstrates growth a single bacterium following colony counts: (1) any aspiration, (2) >5 × 104 CFU/ml catheterization, (3) >100,000 febrile UTI, bladder ultrasonography (RBUS) routinely performed as soon possible C). RBUS followed up 6 months later acute pyelonephritis and/or VUR Acute DMSA scan can when severe congenital hypodysplasia noted diagnosis doubt clinical presentation Late (>6 after UTI) pyelonephritis, high-grade VUR, recurrent UTIs, abnormal parenchyma follow-up Top-down bottom-up approach suggested VUR. top-down approach, VCUG first UTI. indicated abnormalities apparent either also repeat (LE:2, B).Appropriate antibiotic given immediately has been obtained Initiating therapy oral parenteral antibiotics equally efficacious (>3 months) uncomplicated 2: choice empirical agents guided expected pathogen local resistance patterns total course 7–14 days Circumcision may, but definitively, reduce males breakthrough offered uncircumcised boys countries where circumcision accepted general population B), while childhood rarely performed, other measures UTI/VUR preferred 4, Bladder bowel dysfunction (BBD) one key factors progression scarring 2). Early recognition management BBD important prevention recurrence Antibiotic prophylaxis prevent moderate high (III–V) 1b, Surgical intervention may used treat setting because shown decrease incidence