Overview
Febrile urinary tract infection (fUTI) is a significant infection that can affect children and adults. In children, fUTI is conventionally treated with a standard course of oral antibiotics, but shorter durations are being investigated 1.Diagnosis
The diagnosis of fUTI is based on clinical presentation and laboratory confirmation of infection.
The utility of kidney ultrasonography after a first fUTI in children is debated, with varying recommendations 2.
A systematic review found a prevalence of urinary tract abnormalities on kidney ultrasonography after first fUTI in children, but the clinical importance of these findings varies 2.Management
For well-appearing children with fUTI, a 5-day course of oral amoxicillin-clavulanate may be noninferior to a 10-day regimen regarding UTI recurrence within 30 days 1.
The recurrence rate of fUTI within 30 days was lower in a group receiving a 5-day course of amoxicillin-clavulanate compared to a 10-day course 1.Special Populations
Pediatric patients aged 3 months to 5 years with uncomplicated fUTI were included in a study comparing 5-day versus 10-day amoxicillin-clavulanate therapy 1.Key Recommendations
A 5-day course of oral amoxicillin-clavulanate is a potential alternative to a 10-day course for treating febrile urinary tract infections in well-appearing children aged 3 months to 5 years, with a lower recurrence rate observed in a randomized trial 1. (Evidence: Strong)
The clinical utility of routine kidney ultrasonography after a first febrile UTI in children remains a subject of controversy, with differing guideline recommendations 2. (Evidence: Moderate)References
1 Montini G, Tessitore A, Console K, Ronfani L, Barbi E, Pennesi M. Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial. Pediatrics 2024. link
2 Yang S, Gill PJ, Anwar MR, Nurse K, Mahood Q, Borkhoff CM et al.. Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children: A Systematic Review and Meta-analysis. JAMA pediatrics 2023. link