Guidelines recommending aggressive testing of young children with fevers for urinary tract infections (UTIs) should be revisited given the lack of evidence and long-term justification, according to research published online in the Annals of Emergency Medicine.
Noting that the American Academy of Pediatrics’ guidelines recommend aggressive diagnosis, treatment, and investigation of possible pediatric UTIs with fever who are younger than two years, David H. Newman, MD, of the Mount Sinai School of Medicine in New York, and colleagues reviewed the literature to examine the utility and efficacy of this early identification and treatment. They focused specifically on the utility of antibiotics for reducing delayed renal complications and the utility of timely diagnosis and treatment in prevention of renal scarring.
Although two studies linked aggressive and early identification of UTI with prevention of long-term renal complications, a more substantive body of evidence did not find evidence for this link, the researchers reported. In addition, renal scarring was found to be relatively common, but there was no evidence suggesting that scarring has long-term sequelae.
“Pediatric urinary tract infection in well children does not appear to result in currently identifiable long-term clinical sequelae, and antimicrobial treatment appears unable to affect either intermediary markers such as renal scarring or long-term outcome,” the investigators wrote. “Aggressive testing may be more harmful than helpful. An initial observational approach to well children with fever seems reasonable.”