Revised Indian Society of Pediatric Nephrology Guidelines 2023 on UTIand VURManagement

Prompt diagnosis and treatment of urinary tract infections (UTIs) in children are crucial to prevent complications. Children with recurrent UTIs require thorough evaluation and follow-up for effective management.

Key updates from the Indian Society of Pediatric Nephrology's revised guidelines on UTIs and primary vesicoureteric reflux are:

UTI Treatment:

• Initiate antibiotic therapy within 48-72 hours of fever onset.
• Use 3rd-generation cephalosporins or amoxicillin-clavulanic acid as initial empirical therapy for suspected febrile UTI in children.
• For adolescents with cystitis, start with first-generation cephalosporins (cephalexin, cefadroxil) or amoxicillin-clavulanic acid.
• Prefer oral antibiotics over intravenous for acute febrile UTI, except in infants under 2 months, severely ill patients, or those unable to take oral medication.
• Only change initial antibiotics in case of clinical treatment failure, regardless of the sensitivity patterns.
• Prescribe antibiotics for 7-10 days for acute symptomatic UTI in children.
• A 3-to-7-day course of oral antibiotics is recommended for children with cystitis.
• Antibiotics should not be used for asymptomatic bacteriuria; urine cultures are unnecessary for asymptomatic children.

Management of Primary VUR:

• Surgical reimplantation can be considered for patients with high-grade VUR and recurrent febrile UTI despite antibiotic prophylaxis.
• Surgery may be an option for parents hesitant towards antibiotic use in children with high-grade VUR.
• For surgical intervention, endoscopic injection of a bulking agent can be an initial option, though it has a lower success rate compared to ureteric reimplantation.
• Children with high-grade VUR and reflux nephropathy require regular follow-up to monitor growth, blood pressure, proteinuria, and kidney function.
• Periodic ultrasound is recommended to monitor kidney growth in persistent high-grade VUR.
• Repeat DMSA scintigraphy only if UTI recurs, and repeat cystography after 4-8 years if necessary.
• Screen siblings under 3 yearsof children with primary VUR using an ultrasound scan.

Source:Meena J, Bagga A, Hari P. Indian Pediatrics. 2024 Feb 26:S097475591600597-.