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CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Urinary tract infection - children - How up-to-date is this topic?
Changes

Version 1.3, revision planned in 2012.

Last revised in April 2008

August 2009 — minor update. Advice from the National Institute for Clinical Excellence guideline on when to suspect child maltreatment has been added to this topic [NICE, 2009]. Issued in August 2009.

December 2008 — minor update to reflect guidance from the Health Protection Agency (HPA) to avoid broad spectrum antibiotics (e.g. co-amoxiclav, quinolones, and cephalosporins) when narrow spectrum antibiotics remain effective, as broad spectrum antibiotics increase the risk of Clostridium difficile, MRSA, and resistant UTIs [HPA and Association of Medical Microbiologists, 2008]. Issued in January 2009.

December 2007 to April 2008 — converted from PRODIGY guidance to CKS topic structure. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting evidence.

The main changes to the recommendations for managing urinary tract infections in infants and children are:

  • Duration of treatment of lower UTI/cystitis is 3 days.
    • However, CKS recommends that nitrofurantoin be prescribed for 7 days as its licence specifies, and the NICE guideline does not specifically recommend prescribing outside the terms of the licence.
  • Duration of treatment of upper UTI/acute pyelonephritis is 7–10 days.

In comparison with previously accepted good practice the NICE guidelines recommend considerably narrower indications for imaging investigations and long term prophylactic antibiotics following a UTI. However, as imaging investigations and prophylactic antibiotics would normally be arranged by (or after consultation with) a specialist, their indications are outside the scope of this CKS topic.

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