Prevention of Urinary Tract Infections: Indian Society of Pediatric Nephrology Guidelines 2023

Summary of Key Recommendations and Clinical Practice Points for urinary tract infection (UTI) Prevention – revised Indian Society of Pediatric Nephrology guidelines 2023:

Antibiotic Prophylaxis for UTI Prevention

·         Avoid using antibiotic prophylaxis for UTI prevention in patients with a normal urinary tract and no bladder-bowel dysfunction.

·         Use antibiotic prophylaxis for preventing recurrent febrile UTI in patients with high-grade (grades 3-5) vesicoureteral reflux (VUR).

·         Consider antibiotic prophylaxis over surveillance in patients with recurrent febrile UTI and bladder-bowel dysfunction, regardless of the presence of primary VUR.

Antenatally Detected Hydronephrosis

·         Do not use antibiotic prophylaxis to prevent UTIs in children with antenatally detected hydronephrosis while awaiting evaluation.

First-Line Antibiotics for Prophylaxis

·         Use cotrimoxazole or nitrofurantoin as first-line antibiotics for prophylaxis in children older than 3 months.

·         Discontinue antibiotic prophylaxis in children older than 2 years if they meet all three criteria: toilet-trained, absence of bladder bowel dysfunction, and no febrile UTI in the preceding year.

Circumcision for UTI Prevention

·         Consider circumcision as an intervention for preventing UTI in children at risk of recurrence (high-grade VUR or recurrent UTI).

Cranberry Products for UTI Prevention

·         Suggest using cranberry products for preventing UTI in children with recurrent UTI and a normal urinary tract.

Evaluation for Bladder-Bowel Dysfunction

·         Evaluate all toilet-trained children with UTI for bladder-bowel dysfunction.

Management of Bladder-Bowel Dysfunction

·         Manage all children with bladder-bowel dysfunction using urotherapy to prevent UTI recurrence.

Source: Meena J, Bagga A, Hari P. Indian Pediatrics. 2024 Apr;61(4):363-9.