Urinary tract infections (UTIs) are common in infancy and childhood, affecting approximately 6–7% of girls and 2–3% of boys. Fourteen years have passed since the Royal College of Physicians published clinical guidelines for the management of UTI in children. Large numbers of children undergo imaging investigations and receive antibiotic prophylaxis for extended periods. A Cochrane systematic review in 2004¹ found inadequate data from available randomised controlled trials (RCTs) to provide evidence as to whether any intervention (antibiotics or surgery) in children with vesico-ureteric reflux confers worthwhile health benefits.

In 1999 the American Academy of Pediatrics published a guideline on the diagnosis and management of UTI in children under the age of 2 years, based on a rigorous literature search.² However, this did not investigate the evidence for a link between childhood UTIs, renal abnormalities, and long term outcome with or without treatment, and its recommendations are therefore open to question.³ Although the National Institute for Health and Clinical Evidence (NICE) is undertaking an evidence based guideline on the subject, this will not be published until May 2007.

In the meantime, three recent systematic reviews address aspects of the management of UTI, and provide a useful insight into current evidence as a basis for clinical practice.

NHS REVIEW

The first was carried out by the York University Centre for Reviews and Dissemination for the National Health Service R&D Health Technology Assessment Programme.⁴ Its findings are summarised in Effective Health Care.⁵ It covers the evidence for the diagnosis and evaluation of UTIs in children under 5 years of age.

Key points

• UTI is common in children under five. Children …