The evidence behind the new AAP UTI guideline: shorter, oral, and less prophylaxis

The edition in brief

The American Academy of Pediatrics has revised its clinical practice guideline on urinary tract infection in young children, and two technical reports published on 28 September set out the evidence. The diagnostic report explains a revised definition that includes pyuria as a criterion, with thresholds by age and by whether culture results are available, and culture criteria that vary by age and collection method, aiming to reduce overdiagnosis without missing true infection. The management report pooled 60 studies: courses of seven days or fewer may not increase recurrence and probably cause fewer adverse effects; oral treatment may be as effective as intravenous; continuous prophylaxis for reflux or bladder and bowel dysfunction may not reduce breakthrough infection or scarring but may increase resistant infections; and evaluation within 72 hours of symptoms may be linked to less scarring. Certainty was low to very low throughout. An umbrella review of 23 meta-analyses covering 2.8 million children found screen use associated with lower academic achievement and language, and more emotional and peer problems, with small effect sizes. A meta-analysis of 39 cohorts found survivors of childhood, adolescent and young adult cancer had about double the cardiovascular risk of peers, rising to 2.5 times for childhood cancers. The pearl covers urine collection in young children. There was no FDA activity for this desk today.