New guidelines: No routine VCUG in infants with UTIs

New guidelines from the American Academy of Pediatrics (AAP) do not recommend routine use of voiding cystourethrography (VCUG) after the first UTI in febrile infants and children aged 2 to 24 months.

Instead, the clinical practice guideline says that VCUG is indicated “if renal and bladder ultrasonography reveals hydronephrosis, scarring, or other findings that would suggest either high-grade VUR or obstructive uropathy and in other atypical or complex clinical circumstances.” Recurrence of a febrile UTI also would call for VCUG.

To diagnose UTI, pediatricians should document the presence of both pyuria and at least 50,000 colonies per mL of a single uropathogenic organism in a urine specimen, according to the guidelines. The document also urges clinical follow-up after 7 to 14 days of antimicrobial treatment to aid in diagnosis and treatment of any recurrent infections.

Another key recommendation is the use of ultrasonography of the kidneys and bladder to detect anatomic abnormalities. The guidelines also state that data from recent clinical studies do not support the use of antimicrobial prophylaxis to prevent febrile recurrent UTI in infants without vesicoureteral reflux (VUR) or with grade I to IV VUR.

The guideline is set to be updated every 5 years, but data from ongoing studies could require updates sooner.

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