The American Academy of Pediatrics has revised its urinary tract infection guidance, expanding recommendations for infants and young children, emphasising individualised diagnosis, shorter antibiotic courses, and removing race from risk assessment to improve care and reduce unnecessary treatments.
The American Academy of Pediatrics has updated its guidance on urinary tract infections in children for the first time since 2011, widening the recommendations to cover infants and children younger than five and pushing clinicians towards a more individualised approach to diagnosis and treatment. Published in the academy’s journal Pediatrics, the new guidance is designed to make detection more practical, reduce unnecessary antibiotic use and remove race from risk assessment.
Brian Alverson, who chaired the panel behind the update, told Medscape that the changes could alter everyday practice in paediatrics. He said the aim was to recognise that UTIs remain an important concern in babies older than eight days and in young children, especially when fever is the only symptom and the illness can be mistaken for a viral infection. The academy says UTIs affect about 7% of infants who present with fever, while a systematic review in Pediatrics put the rate at roughly 6% to 8% among febrile infants and children seen in general practice.
The revised guidance urges doctors to combine symptoms, urinalysis, urine culture and clinical judgement rather than rely on a single test or rule. It recommends that clinicians assess children aged two to five years within 72 hours of symptom onset when infection is suspected, and that children aged two to 24 months with fever and no clear source be evaluated on the same timetable. The update also places greater emphasis on constipation and bladder-bowel dysfunction, which the academy says are common contributors to recurrent infection. Research published alongside the guidance found that more than 30% of children with UTIs have repeat infections, with vesicoureteral reflux and bowel and bladder dysfunction among the main risk factors.
Treatment advice has also shifted towards shorter courses of antibiotics. The academy says most children should not need more than seven days of therapy, while lower-risk children aged two and older may be suitable for three to five days. Children younger than two years generally still need at least five days. The guidance supports oral antibiotics for children older than 28 days and says infants aged eight to 28 days can move from intravenous to oral treatment once they improve. Another notable change is the removal of race as a factor in clinical assessment, with the academy saying race is not a biological marker of UTI risk and should not shape decisions about care. Amanda North, a paediatric urologist at Montefiore Health System, told Medscape the update should help primary care doctors by clearing up confusion over diagnosis and treatment length.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
