In children suspected of having a UTI, what clinical and radiological features diagnoses pylonephritis, and what mode of antibiotic treatment is necessary to produce clinical improvement and avoid chronic renal impairment?

With the publication of the NICE guidance in the UK on the management of UTI in childhood, many paediatricians have been spurred to review their understanding of the evidence underpinning certain aspects of the clinical pathway.Questions about pyelonephritis are being asked in the City Hospital, Birmingham, UK – how should it be diagnosed, and treated with what sorts of antibiotics, given by which route, and for how long? The questions are certainly open for debate — as is this blog entry.

Can we reliably differentiate between a bladder and a kidney infection in children? Does the diagnosis make any difference anyway? Do you really need 48h of IV antibiotics just because you’re <12m old with white cells in your urine?

Acnowledgements:

Image: mariaboismain from Flickr under the creativecommons2.0 licence.