Infection of the urinary tract occurs after bacteria from the gastrointestinal tract colonize the urethra and a misbalance between the host responses and bacterial virulence. Symptoms vary depending on the location of the infection (lower or upper tract) and the age of the child. The gold standard for diagnosis is the urine culture. The urinalysis has good sensitivity and specificity and inflammatory markers although usually elevated are not perfect markers of infection. Voided urine or “bagged” specimens are not recommended and catheterized samples are necessary in children who are not toilet trained. After the first episode of urinary tract infection (UTI) in a young child, a renal and bladder ultrasound is recommended. The goals of treatment are eliminate the infection and prevent renal scarring. Oral and intravenous (IV) routes are feasible depending on the clinical situation; starting IV therapy with transition to oral is acceptable. Antibiotics commonly used in the treatment of UTI in children include cephalosporins, amoxicillin-clavulanate acid, and trimethoprim-sulfamethoxazole, but fluoroquinolones, aminoglycosides, and nitrofurantoin may be used in some scenarios. Given growing resistance of common uropathogens to various antibiotics, it is important to review susceptibility testing results and alter the selected antibiotic regimen accordingly.
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