The AAP Practice Parameter on Urinary Tract Infections in Febrile Infants and Young Children
KENNETH B. ROBERTS, M.D.
University of North Carolina School of MedicineChapel Hill Greensboro, North Carolina
The Committee on Quality Improvement of the American Academy of Pediatrics developed an evidence-based practice parameter on the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children, two months to two years of age. The practice parameter consists of 11 recommendations and four areas for future research. Recommendations 1 through 5 address diagnosis and emphasize the need for culturing appropriately collected specimens; diagnosis should not be based on urinalysis or on culture of specimens from urine-collection bags. Recommendations 6 through 10 address treatment, identifying trimethoprim-sulfamethoxazole as superior to amoxicillin and establishing the duration of treatment as seven to 14 days. Children should receive antimicrobial coverage until imaging studies have been completed. Recommendation 11 addresses imaging; all infants should undergo ultrasonography, and a lower tract study is strongly encouraged as well. Future research should quantitatively address the relationship between renal scarring in childhood and renal impairment and hypertension in adults. Less invasive methods of diagnosis and imaging are highly desirable and should be developed.
Am Fam Physician 2000;62:1815-22. Open Access Article.
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In an effort to improve the diagnosis, treatment and evaluation of febrile infants with urinary tract infection (UTI), the American Academy of Pediatrics (AAP) has published 11 recommendations addressing the condition. This article summarizes the recommendations made by the AAP in its report, titled "Practice Parameter: the Diagnosis, Treatment, and Evaluation of the Initial Urinary Tract Infection in Febrile Infants and Young Children."1 The practice parameter was developed by the Subcommittee on Urinary Tract Infection of the AAP Committee on Quality Improvement and reviewed by the American Academy of Family Physicians (AAFP) and other groups.
UTI was selected for practice parameter development because of the associated morbidity, frequency, cost and variation in diagnosis or management. To meet the morbidity criterion, febrile infants and young children two months to two years of age with UTI were selected as the target group. (Febrile infants younger than two months may be at even higher risk of renal damage but are being addressed by another subcommittee of the AAP.)
Morbidity is not limited to acute illness because the UTI may result in renal scarring, with the potential to diminish renal function and contribute to hypertension in adulthood. The costs associated with UTIs include the usual expenses associated with acute illnesses--medication, office visits, loss of parental time from work--as well as expensive imaging studies and the potential for high costs associated with renal impairment and hypertension. Variation in diagnosis and management includes from whom and by what method urine is obtained, how specimens are processed, the route and duration of treatment, and whether radiographic imaging is performed.
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